Medical Director

Company: MEDCOST LLC
Location: Winston Salem
Posted on: September 12, 2020

Job Description:

MedCost excels at helping businesses provide quality health care in a way their company and its employees can afford. Joining MedCost means working alongside enthusiastic, customer-focused teams—people who seek innovative solutions and are passionate about delivering exceptional results. That's why we are committed to investing in individuals and our thriving professional culture. Our work environment is built on appreciation and flexibility, personal and professional growth opportunities and competitive compensation and benefits.

We invite you to advance your career with MedCost and contribute to the growth and success of our company. MedCost LLC does not discriminate on the basis of race, color, national origin, sex, age or disability.

MedCost excels at helping our clients lower their health plan costs so they ca n provide more affordable benefits. This success is driven by enthusiastic, customer-focused employees — people who seek innovative solutions and are passionate about delivering exceptional results. That’s why we are committed to investing in our workforce and fostering a thriving professional culture. When you join us, you’ll enjoy a positive work environment built on appreciation and flexibility, opportunities to grow personally and professionally, and competitive pay and benefits. We invite you to advance your career with MedCost and contribute to the growth and success of our company.

Medical Director

Reports to: President/Chief Executive Officer

FLSA Status: Exempt

Position Summary:

MedCost is seeking a full-time Medical Director to drive measurable and meaningful improvement in the use of evidence-based medicine, clinical variation, and affordability in our journey to support transformative care. The Medical Director provides strategic and clinical oversight for authorization review, population health expansion, clinical program development, clinical policy creation and governance, and business development initiatives that align with the MedCost goals and company objectives. This includes the development and support of medical necessity utilization review, value-based care programs, provider quality assessment and performance improvement, continuing education for clinical staff, and communication of clinical performance and outcomes. The Medical Director provides oversight of the development of policies, practices, and systems to monitor and implement quality control standards and measurements while ensuring compliance with regulatory agencies’ standards and requirements.

Brief Summary of Position Responsibilities, full job description will be available during the interview process:

Support the development and execution of MedCost strategy.

Provide daily physician review determinations on matters including appropriateness of medical care utilization, medical necessity, quality of care issues and appropriateness of medical treatment including Authorizations, Pre-Determinations and Appeals in accordance with DOL and accreditation standards to support the inpatient and outpatient utilization review and case management authorizations.

Participate in telephonic outreach for collaboration with treating providers. This will include daily peer level reviews, discussion of evidence-based guidelines, opportunities to close clinical quality/service gaps, and care plan changes that can impact health care expenses.

Lead the physician advisory panel including credential approval and assistance in the recruitment, training, and assurance of quality outcomes from the authorization reviews.

Provide oversight of all clinical aspects of the credentialing program and Credentialing Committee including active participation in the development and ongoing review of policies and procedures to ensure compliance with DOI and accreditation standards.

Develop, implement, and ongoing governance of clinical criteria and medical policies.

Provide review of physician credentials and/or quality for the purpose of value-based reimbursement and network participation.

Strengthen clinical program offerings through incorporation of emerging scientific advancements, staff education and program integration with health system partners.

Utilize advanced analytics for population modeling, regression analysis, advanced risk stratification and predictive modeling to identify emerging opportunities for population intervention.

Participate in clinically appropriate business development activities such as prospect presentations, continuing education seminars and other business growth opportunities.

Position Qualifications: Required

MD with an active, unrestricted medical license in the state of N.C.

Medical degree from accredited university

Current Board Certification

Minimum of 2 years of experience as a physician executive in a managed care environment

Minimum of 5 years of clinical practice experience

Ability to travel up to 50% in tri-state area for client retention, business development and other applicable business-related meetings and events

Preferred Previous experience as a Medical Director in a managed care organization

MMM, MBA, or CPE

Population Health or Analytics Experience

Background in Primary Care, Family Medicine or Emergency Medicine

Access to Protected Health Information (PHI) This position requires the employee to handle PHI for duties related to enrollment and eligibility

issues. Access to the PHI includes the MBS claim system, eligibility files and any other source necessary to complete client enrollment. Policies and Procedures will be strictly adhered to make sure PHI is protected as required by the HIPAA Privacy Rule.

Privacy and Security Responsibilities:

Responsible and accountable for maintaining the confidentiality, integrity, and availability of protected health information. Follow HIPAA security policies and procedures affecting your job and report any suspected or actual violation or breach.

Essential Physical Functions:

This position operates in a professional office environment. This role routinely uses standard office equipment. While performing the duties of this position, the employee is occasionally required to stand; walk; sit, push, pull; use hands to finger, handle, or feel objects, tools or controls, reach with hands and arms; climb stairs; talk and/or hear. The employee must occasionally lift or move office products and supplies, up to 20 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants .

Keywords: MEDCOST LLC, Winston-Salem , Medical Director, Other , Winston Salem, North Carolina