What are the responsibilities and job description for the Medical Director Leadership Role position at Arizona Complete Health?
Job Description:
You could be the one who transforms healthcare for 28 million members as a clinical leader on our Medical Management/Health Services team. We offer a fresh perspective on workplace flexibility, and you'll have the opportunity to make a real impact.
The Chief Medical Director relies on your expertise to direct and coordinate medical management, quality improvement, and credentialing functions for the business unit. You will provide medical leadership in utilization management, cost containment, and medical quality improvement activities. Your responsibilities include performing medical review activities related to utilization review, quality assurance, and medical review of complex or experimental services. This involves ensuring timely and high-quality decision-making processes.
Your tasks also include supporting effective implementation of performance improvement initiatives for capitated providers, assisting the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Additionally, you will provide medical expertise in the operation of approved quality improvement and utilization management programs according to regulatory, state, corporate, and accreditation requirements.
In this role, you will collaborate with clinical teams, network providers, appeals teams, and medical consultants to review complex cases and medical necessity appeals. You will also participate in provider network development and new market expansion, assist in the development and implementation of physician education regarding clinical issues and policies, and identify utilization review studies and evaluate adverse trends in utilization of medical services.
You could be the one who transforms healthcare for 28 million members as a clinical leader on our Medical Management/Health Services team. We offer a fresh perspective on workplace flexibility, and you'll have the opportunity to make a real impact.
The Chief Medical Director relies on your expertise to direct and coordinate medical management, quality improvement, and credentialing functions for the business unit. You will provide medical leadership in utilization management, cost containment, and medical quality improvement activities. Your responsibilities include performing medical review activities related to utilization review, quality assurance, and medical review of complex or experimental services. This involves ensuring timely and high-quality decision-making processes.
Your tasks also include supporting effective implementation of performance improvement initiatives for capitated providers, assisting the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Additionally, you will provide medical expertise in the operation of approved quality improvement and utilization management programs according to regulatory, state, corporate, and accreditation requirements.
In this role, you will collaborate with clinical teams, network providers, appeals teams, and medical consultants to review complex cases and medical necessity appeals. You will also participate in provider network development and new market expansion, assist in the development and implementation of physician education regarding clinical issues and policies, and identify utilization review studies and evaluate adverse trends in utilization of medical services.
