What are the responsibilities and job description for the Senior Medical Director Medical position at Quartz Health Solutions?
Senior Medical Director Medical - MADISON, WIJob InformationJob Order ID : WI3788805# of Positions : 1Experience Required : 12 years of direct clinical patient care experience post residency or fellowship, with at least 3 years working in a managed care setting.Shift : UnspecifiedJob DescriptionAre you a physician leader with experience working in a managed care setting? Are you ready to revolutionize healthcare and make a lasting impact on the well-being of communities? We are seeking an experienced Senior Medical Doctor to lead our Medical Management.As the Senior Medical Director specializing in Medical Management, you will oversee a team of Associate Medical Directors and be responsible for second level medical necessity reviews, offering expert medical opinion and guidance on complex cases.ResponsibilitiesConduct medical necessity reviews and determinations of prior authorizations and referrals, including reviews of previously denied and appealed decisions.Oversee and manage a team of Associate Medical Directors, including performance management, timekeeping, and managing the MD calendar to ensure adequate coverage during business hours.Provide clinical strategy and physician input to various Clinical Services departments, including Utilization Management, Care Management, Medical Policy, Behavioral Health, Population Health, Quality, and Clinical Informatics.QualificationsMD or DO with current and ongoing Board Certification in an ABMS Medical Specialty.Unrestricted current medical license in the state of Wisconsin and other states as necessary.Knowledge of medical management principles, including utilization management, prior authorization, case management, concurrent and retrospective review.Familiarity with the National Committee for Quality Assurance (NCQA) Health Effectiveness Data and Information Set (HEDIS) principles, accrediting requirements, and CMS Star ratings for Medicare lines of business.Ability to plan, organize, and execute assignments to meet deadlines.Ability to communicate in a manner that builds constructive, effective relationships with colleagues.#J-18808-Ljbffr
