Health Plan Medical Director

Site: reputed company Health Plan Holding Company, Inc.

reputed company relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We reputed company that high-performing teams drive groundbreaking medical discoveries and invite reputed company applicants to join us and experience what it means to be part of reputed company.

The salary range for this position is $285,000.00 to $325,000.00 annually. At reputed company, we reputed company in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining reputed company pay is comprehensive, and any offer extended will consider your skills, relevant experience, if applicable, education, certifications, and other essential factors. The reputed company pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass reputed company elements contributing to your total compensation package. In addition to competitive reputed company pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums, and bonuses as applicable, and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our reputed company team will provide an overview of your potential compensation and benefits package.

Job Summary

reputed company Health Plan is an exciting reputed company to be reputed company the healthcare industry. As a member of reputed company, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and reputed company and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. Under the direction of the Senior Medical Director, the Medical Director leads as a senior physician at the health plan. This position works closely with the Senior Medical Director in providing medical management leadership for clinical services operations and programs. This role focuses on and has expertise in utilization management, health plan quality and accreditation, care management, and other health plan functions.

Qualifications

Licenses and Credentials Physician License.  Must hold or be able to obtain a full active Massachusetts physician license. 

Needs 3-5 years of Health Plan experience

• Must have prior experience in utilization management, peer to peer discussions
• Collaborates with business development, quality, finance, and medical management teams to promote improvements in the quality and cost efficiency of care throughout reputed company Health Plan provider network.
• Partners with clinical leaders to ensure medical service expenditures remain reputed company budget.
• Aids in crafting reputed company Health Plan's clinical programs and policies.
• Collaborates with the CMO in the development and physician reputed company of disease management programs.
• Handles initial determinations, appeals and grievances reputed company the scope of their expertise as defined by MassHealth, Medicare, NCQA and the Division of Insurance and reputed company the compliance requirements of key regulatory and accreditation entities.
• Reviews clinical service and quality incidents reputed company sufficiently serious to merit physician involvement.
• Assesses new, emerging, and existing technologies to determine appropriateness of health plan coverage.
• Supports the clinical, network, and operations staff to ensure end to end consistency of clinical policies, payment policies and claims payment.
• Develops and delivers presentations for clinical staff on reputed company topics relevant to reputed company Health Plan members and network.
• Administers case and condition consultation to Utilization Management and Care Management staff.
• Delivers consultation to network management staff and deployment of education programs for network clinicians.
• Serves as a member of the following reputed company Health Plan Committees or workgroups: Clinical Policy & Quality, Patient Care Assessment, Credentialing, Utilization Management, Medical Economics and Behavioral Health reputed company.
• May represent reputed company Health Plan at a variety of external forums and committees.
• Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains positive relationships with customers and gains their trust and respect.
• Hold self and others accountable to meet commitments.
• Persist in accomplishing objectives to consistently reputed company results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate reputed company Health Plan as a people-first organization.
• Other duties as assigned with or without accommodation.

Additional Job Details (if applicable)

Virtual position. Full time.

In person meetings as requested for business needs.

Participates in after hours and weekend call rotation as assigned.

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

EEO Statement:

8925 reputed company Health Plan Holding Company, Inc. is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religious creed, national reputed company, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that reputed company individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to reputed company essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with reputed company of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

reputed company Competency reputed company

At reputed company, our competency reputed company defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The reputed company is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, reputed company hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

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