University of Maryland Medical System Health Plans, Inc.
March 7, 2018
Full Time - Experienced
The Medical Director works with the clinical staff on all day-to-day Utilization Management (UM) and Quality Improvement (QI) operations. The Medical Director assists the Chief Medical Officer, Vice President of Health Services and the Director of Quality in developing medical policy and UM and QI initiatives. The Medical Director also may chair the Credentialing Committee and the Medical Management Review Committee if designated by the CMO.
Essential Duties and Responsibilities:
•Functions as an integral part of the Health Services team to provide clinical perspectives to operations, business, and managed care activities
•Provides guidance on activities for the clinical staff with focus on clinical delivery, utilization management, and clinical outcomes
•Responsible for making Utilization Management determinations for medical and pharmacy pre-service, post-service, and concurrent review requests
•Responsible for making first level appeal determinations for cases where he/she did not make an initial determination
•Works proactively with concurrent review nurses to optimally monitor and improve the efficiency of inpatient care
Required Education, Experience and Qualifications:
•Medical degree (MD or DO) with an active, unrestricted license to practice medicine in the States that University of Maryland Medical System Health Plans is contracted to manage member health needs.
•A minimum of two years post- residency clinical experience
•Current Board certification from a board recognized by the American Board of Medical Specialties, or a specialty board recognized by the American Osteopathic Association.
Preferred Education, Experience and Qualifications:
•Current Board Certification in a Primary Care Specialty
•Two years of managed care experience
•Previous exposure to utilization management activities such as projects, committees or other documented exposure.
•Recent hospital inpatient management experience.
Knowledge, Skills and Abilities:
•Ability to develop and manage the clinical, utilization, and quality assurance systems
•Ability to respond and adapt to complex, fast paced rapid growth, and results-oriented environment
•Willingness to “roll up one’s sleeves” and embrace the nitty gritty, bottom up task of building an organization and implementing a new model.
•Personal and professional track record that demonstrates a commitment to quality in health care.
•A positive attitude: ability to work hard, have fun, and operate efficiently in a fast paced, start up, work environment and in a highly complex and dynamic movement for health delivery reform.
•Proficiency in Microsoft and or Apple platforms •Familiarity with Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems
Internal Number: MD02
About University of Maryland Medical System Health Plans, Inc.
The University of Maryland Medical Systems Health Plans is a managed care organization supporting both Medicaid and Medicare recipients in the state of Maryland.