What are the responsibilities and job description for the Network Relations Medical Director position at MCS Healthcare Holdings, LLC.?
Join to apply for the Network Relations Medical Director role at MCS Puerto Rico .GENERAL DESCRIPTION : Represents the company in physician-related outreach activities. Develops and maintains relationships with peers to support the company’s network management initiatives.ESSENTIAL FUNCTIONS : Provide medical expertise recommendations for the goals and initiatives in the department.Evaluate and discuss PCP and VIP network providers' performance.Supports the education of network physicians about utilization management, care management programs, and other initiatives requiring their support.Serve as liaison for network physicians with questions, suggestions, feedback, and complaints.Participate in various physician-related committee activities.Provide resource information to Provider Services staff, as needed, on medical-related issues.Conduct regional, office-based, or in-house meetings with physicians to discuss their performance in terms of utilization management, coding, documentation, and quality of care, among others.Provides medical advice and works or serves as a medical expert for other units, as assigned or required by the business needs.Represents the Company during interventions with providers or regulatory agencies, as needed.Participates in medical consultation committees.ADDITIONAL FUNCTIONS : Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.MINIMUM QUALIFICATIONS : Education and Experience : MD degree. Residency trained. Subspecialty preferred. At least five (5) years of experience in the performance of clinical duties, which includes, at least two (2) years of managed care experience, preferably within the healthcare industry, such as hospital or health insurance.Certifications / Licenses : An active license to practice medicine in PR is preferred.Languages : Spanish – Advanced (comprehensive, writing and verbal)English – Advanced (comprehensive, writing and verbal)Seniority level : Mid-Senior levelEmployment type : Full-timeJob function : Health Care ProviderIndustries : Insurance#J-18808-Ljbffr
