Administrative Physician - Physicians Only Apply - Perm - Saint Louis Missouri

Company: Catherine Stenberg
Location: Saint Louis, Missouri
Posted On: 05/09/2024

A Administrative Physician practice is seeking a qualified physician for St. Louis, MO. This and other physician jobs brought to you by ExactMD. Medical Doctors Only Apply.


Senior Medical Director
This job will have the following responsibilities:

• Lead, develop, direct and implement clinical and non-clinical activities that impact health care quality, cost and outcomes.--
  
• Direct the utilization review process and oversee the quality of utilization determinations.--
  
  
  
• Be responsible for overall medical policies of the unit to ensure the appropriate and most cost effective medical care is received.--Recommend changes and enhancements to current managed care, review guidelines, and clinical criteria .
  
• Develop, implement, and interpret medical--polices.--
  
• Lead clinical staff in the coordination of quality care.
  
  
  
• Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
  
  
  
• Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
  
  
  
• Responsibility for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and--reimbursement expertise.
  
  
  
• Expand--their medical management programs to address member needs across the continuum of care.
  
  
  
  
  
  
  
  
  Qualifications & Requirements:
  
  
  • 3 to 5 + years of--experience in the health care delivery system with 3-5 years additional leadership and management experience in the health care industry.
    
  • Active unrestricted--MD or DO license is required.
    
    
    
  • Specialty in Primary Medicine or Internal Medicine preferred.
    
  • Prior Managed Care experience
    
    
    
  • Active unrestricted Board Certification is required. Must be board certified, not board "eligible"
    More...

        

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