Medical Director- Foster Care Job
Location: Atlanta Georgia
Description: Amerigroup is at the momment seeking for Medical Director- Foster Care Job right now, this career will be placed in Georgia. For complete informations about this career opportunity kindly see the descriptions. Medical Director- Foster Care
Job ID 2013-23623 # Positions 1
Location US-GA-Atlanta
Search Category Medical Director
Type Regular Full-Time (30+ hours) Poste! d Date 8/5/2013
Additional Locations ..
More information about this job:Summary:
Provides support in overseeing medical care for Amerigroup products and services and works collaboratively with other functions that interface with medical management such as provider relations, member services, benefits and claims management. Collaborates with other business leaders, corporate and health plan medical directors to carry out national medical policies.
Responsibilities:
1. Assists in managing medical costs and assuring appropriate health care delivery for Amerigroup health plans, products and services.
2. Provides guidance, support and leadership for utilization management activities.
3. Supports Medical Director(s) in all aspects of utilization, quality and network management.
4. Provides support to nurses and clinical leaders in pre-authorization, concurrent and retrospective review decisions, case ma! nagement and disease management decisions.
5. Assists! Medical Directors and/or National Medical Directors with medical policy; participates in policy review, reviews trends and makes recommendations; may plan, organize and/or direct medical services programs, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.
6. Assists in the design and implementation of corrective action plans to address issues and improve plan and network managed care performance.
7. Supports URAC, AHCA and NCQA qualification activities. Prepare for site visits and responds to accrediting and regulatory agency feedback.
8. Participates in risk management, claims adjudication, utilization management, catastrophic case review, education and outreach programs, HEDIS reporting, credentialing, peer to peer review, appeals review, denials, etc.
9. Participates in the development of strategic planning for existing and expanding business. Recommends changes in program ! content in concurrence with changing markets and technologies.
10. Other duties as assigned or requested
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- MD or DO, with board certification in area of specialty.
- Masters in Public Health, MBA or MA.
Required:
- Minimum of five years clinical experience with at least two years in medical management/health administration in a managed care environment.
Required:
- Active license to practice medicine without restriction issued by the State Board of Licensure or the State Board of Osteopathic Examiners. Certified in a recognized medical specialty as recognized by the American Board of Medical Specialists (ABMS).
- Certification b! y the American Board of Quality Assurance and Utilization Review Physic! ians or the American Board of Medical Management
Required:
- English
- Think creatively, Innovative
- Understanding of financial and business acumen
- Collaborative team player; active listening skills
- Excellent verbal and written communication skills and ability to build and sustain strong working relationships
- Organizational skills and demonstrated ability to multitask and execute
- Strong people leadership and influencing skills
- Strong project management skills; ability to drive programs and lead change
- Knowledge of medical, quality improvement and utilization management practices in a managed care environment
- Knowledge of regulatory and accreditation agencies and requirements
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office! equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.
- Ability to read, comprehend and interpret complex information and trends to provide accurate and appropriate information to business partners and/or customers.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
# Direct Reports: As assigned
# Indirect Reports: As assigned
Budge! tary $ Responsibility: As assigned
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Amerigroup.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Tue, 06 Aug 2013 03:45:37 GMT
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