The Medical Director supports projects within Maximus’s Clinical Services Division, which performs a wide array of clinical assessment services for individuals with physical and/or mental disabilities seeking Medicaid-funded services and supports. The Medical Director serves as the project’s chief medical expert. The Medical Director provides consultation and training to project leadership and Registered Nurse (RN) reviewers to ensure all clinical reviews adhere to standards set forth in law and regulation and expectations set by the client and executive leadership. The Medical Director reports to the Project Director.
1. Provide consultation as needed to clinical review teams regarding complex cases, as well as mediation and appeals cases.
2. Direct quality assurance oversight of nurse and physician work products.
3. Provide advice and counsel to the client as directed.
4. Drive innovative solutions to include automation to ensure cutting edge strategies & implementation of best practices within our industry.
5. Direct the development of training materials for nurses and physicians.
• Maintains primary responsibility for ensuring customer satisfaction, resolving compliance issues, accountability for profit & loss and adherence to operational budgets with assigned contracts.
Knowledge, Skills & Abilities
• Ability to demonstrate not less than two years' experience in a management role with oversight of quality assurance or medical management functions, including disability review/evaluation and evidence-based medicine research or application.
• Ability to work effectively in a “hands-on” management role, motivating staff through variety of communications vehicles to include remote working when necessary.
• Assist program staff in consistent interpretation of relevant all federal and state-specific criteria and guidelines
• Direct and control the activities of a broad functional area through several department managers within the company.
• Has overall control of planning, recommending and implementing changes to methodology and standards for performance.
• Work on complex issues where analysis of situations or data is utilized to accurately drive performance decisions and/or company NC business trajectory.
• Participate in corporate development of methods, techniques and evaluation criteria for projects, programs, and people.
• Regularly interact with executives and/or major customers.
• Excellent organizational, interpersonal, written, and verbal communication skills.
• Ability to successfully execute many complex tasks simultaneously.
Doctorate of Medicine, board-certified and licensed to practice medicine in North Carolina and meet stringent credentialing standards. Expertise in North Carolina Medicaid and standards of care strongly preferred.
The job requires seven (7) years of experience managing operations, preferably in Medicaid-funded healthcare program, mental health, or a related field.
Essential Duties and Responsibilities:
- Direct the development of training materials for nurses and physicians.
- Oversee quality assurance of nurse and physician work product.
- Provide advice and counsel to the client as directed.
- Direct and control 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.
- Work on complex issues where analysis of situations or data requires an in-depth knowledge of the company.
- Participate in corporate development of methods, techniques and evaluation criteria for projects, programs, and people.
- Ensure budgets and schedules meet corporate requirements.
- Regularly interact 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.
- Report to Senior Director or VP level.