• Medical Director- QIC (Remote)

    Job Locations US-NY-Pittsford
    Posted Date 3 months ago(1/3/2019 9:31 AM)
    Requisition ID
    # of Openings
    Job Schedule
    Regular Full-Time
  • Responsibilities

    REMOTE OPPORTUNITY - The Medical Director serves as the Qualified Independent Contractor program’s chief medical expert. The Medical Director is responsible for ensuring that clinical reviews adhere to the standards set forth in Medicare law and regulation, and in accordance with expectations set by the client and executive leadership. The Medical Director will be the program liaison to the client for all clinical matters and will collaborate with other leadership in the strategic oversight of the program.

    Directs the development of training materials for nurses and physicians
    Oversee and review medical necessity determinations to ensure the consistency of decision-making by physician and other health care professions
    Participates in and oversees medical review case management, including determination of medical necessity according to payment guidelines and regulations; researches investigational or controversial medical procedures; determines utilization, performs coding and medical necessity issues
    Participate in meetings with client or other interested parties to discuss existing and newly developed coverage issues
    Participate in peer review quality oversight of physicians and other health professionals who conduct determinations and perform re-review when necessary and provide feedback to reviewers
    Supervise, schedule and manage internal physician team members
    Participate in the recruitment, training and oversee members of internal and external contracted clinical personnel
    Develop and implement processes resulting in high production while maintaining high quality for utilization and medical necessity review
    Participates in quality assurance programs and operational continuous improvement initiatives to monitor quality and performance
    Perform environmental scan to identify emerging clinical issues.
    Contributes clinical expertise for the development of new business
    Performs other duties as may be assigned by management

    Doctor of Medicine or Osteopathy currently licensed in a US State, with Board certification in one of more specialties recognized by the ABMS (American Board of Medical Specialties) or AOBM (American Osteopathic Board of Medicine). Primary care experience preferred
    At least five (5) years, post Board certification, experience in direct patient care, following the completion of a residency program, required
    Ability to pass stringent credentialing based upon URAC/NCQA type standards
    Knowledge of Medicare programs, particularly coverage and payment rules
    At least two (2) years’ experience in a management role with oversight of quality assurance or medical management functions, including “evidence based medicine” research or application, strongly preferred
    Technology experience with programs, i.e., Microsoft Office (Word and Excel) and ability to research utilizing the internet preferred, including web based portals
    The preferred candidate will have two (2) or more years’ experience as a Medical Director for a Medicare Contractor (e.g., Fiscal Intermediary, Carrier, etc.) or health insurance company and intimate knowledge of Medicare coverage and reimbursement policies, and related issues
    Demonstrates teamwork and promotes positive company relations
    Excellent organizational, interpersonal, written, and verbal communication skills required
    Ability to work as a team member in a fast-paced, deadline-oriented work environment
    Ability to successfully execute many complex tasks simultaneously

    The Ideal Candidate will Possess the Following Additional Education and Experience

    • Directs and controls the activities of a broad functional area through several department managers within the company.
    • Has overall control of planning, staffing, budgeting, managing expense priorities, and recommending and implementing changes to methods.
    • Works on complex issues where analysis of situations or data requires an in-depth knowledge of the company.
    • Participates in corporate development of methods, techniques and evaluation criteria for projects, programs, and people.
    • Ensures budgets and schedules meet corporate requirements.
    • Regularly interacts with executives and/or major customers.
    • Interactions frequently involve special skills, such as negotiating with customers or management or attempting to influence senior level leaders regarding matters of significance to the organization.
    • Reports to Senior Director or VP level.

    EEO Statement

    EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. MAXIMUS is an Affirmative Action/Equal Opportunity Employer. MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.


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