Administrative Physician - Physicians Only Apply - Perm

Company: SmartDocs Direct
Location: Des Moines
Posted on: April 17, 2024

Job Description:

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

Position Purpose: Assist the Chief Medical Director to
direct and coordinate the medical management, quality improvement and
credentialing functions for the business unit.

• Provides
  medical leadership of all for utilization management, cost containment,
  and medical quality improvement activities. Performs medical review
  activities pertaining to utilization review, quality assurance, and
  medical review of complex, controversial, or experimental medical
  services. Supports effective implementation of performance improvement
  initiatives for capitated providers.
  
  
• Assists Chief Medical
  Director in planning and establishing goals and policies to improve
  quality and cost-effectiveness of care and service for members. Provides
  medical expertise in the operation of approved quality improvement and
  utilization management programs in accordance with regulatory, state,
  corporate, and accreditation requirements.
  
  
• Assists the
  Chief Medical Director in the functioning of the physician committees
  including committee structure, processes, and membership. Oversees the
  activities of physician advisors. Utilizes the services of medical and
  pharmacy consultants for reviewing complex cases and medical necessity
  appeals. Participates in provider network development and new market
  expansion as appropriate. Assists in the development and implementation
  of physician education with respect to clinical issues and policies.
  
  
• 
  Identifies utilization review studies and evaluates adverse trends in
  utilization of medical services, unusual provider practice patterns, and
  adequacy of benefit/payment components. Identifies clinical quality
  improvement studies to assist in reducing unwarranted variation in
  clinical practice in order to improve the quality and cost of care.
  Interfaces with physicians and other providers in order to facilitate
  implementation of recommendations to providers that would improve
  utilization and health care quality. Reviews claims involving complex,
  controversial, or unusual or new services in order to determine medical
  necessity and appropriate payment.
  
  
• Develops alliances with
  the provider community through the development and implementation of the
  medical management programs. As needed, may represent the business unit
  before various publics both locally and nationally on medical
  philosophy, policies, and related issues. Represents the business unit
  at appropriate state committees and other ad hoc committees
• 
  Consults on MCO clinical policy related to Substance Use Disorders and
  the cases of individual members for the MCM program on a routine basis.
• 
  
  Education/Experience: Medical Doctor or Doctor of
  Osteopathy, board certified preferable in a primary care specialty
  (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine).
  The candidate must be an actively practicing physician. Previous
  experience within a managed care organization is preferred. Course work
  in the areas of Health Administration, Health Financing, Insurance,
  and/or Personnel Management is preferred. Experience treating or
  managing care for a culturally diverse population preferred.

Keywords: SmartDocs Direct, Ankeny , Administrative Physician - Physicians Only Apply - Perm, Other , Des Moines, Iowa