AmesRecruiter Since 2001
the smart solution for Ames jobs

Chief Medical Director - Des Moines

Company: KVR Consultant
Location: Des Moines
Posted on: September 21, 2019

Job Description:

Description Position Purpose: Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the strategic plan, establishing the strategic vision and attendant policies and procedures. Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations.Oversees internal medical review guidelines to ensure clinical integrity and compliance and acts as a resource for staff members throughout the operation.Coordinates with other departments, the responses needed to address regulatory accreditation concerns pertaining to medical management issuesPerforms medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.Facilitates the achievement of the Medical Management Program goals through an effective health services delivery system.Responsible for physician review and oversight of all potential adverse determinations including pre-certifications/prior authorizations, concurrent review and appeals/retrospective review.Responsible for HEDIS improvement and strategy.Actively participates in the auditing process of medical management processes and corrective action team projects for medical managementAchieves utilization, cost management and quality goals.Participates and advises in the development of corporate medical policies for UM, pharmacy, and new technologyFor Home State Health Plan only – responsible for the sufficiency and supervision of the health plan provider network Additional responsibilities for Pennsylvania Health & WellnessAvailable to the MCO's medical staff for consultation on referrals, denials, complaints and problems.Directly involved in the MCO's recruiting and credentialing activitiesFamiliar with local standards of medical practice and nationally accepted standards of practice, including those for LTSS and with most integrated setting requirements under the ADA.Knowledge of due process procedures for resolving issues between Network Providers and the MCO administration, and between participants and the MCO, including those related to medical decision making and utilization review.Available to review, advise and take action on questionable hospital admissions, Medically Necessary days and all other medical care and medical cost issues.Directly involved in the MCO's process for prior authorizing or denying services and is available to interact with Providers on denied authorizations.Knowledge of current peer review standards and techniques.Knowledge of risk management standards.Directly accountable for all Quality Management and Utilization Management activities.Oversees and is accountable for: (a) referrals to the Department and appropriate agencies for cases involving quality of care and services that have adverse effects or outcomes; and (b) the processes for potential Fraud, Waste, and Abuse audit, investigation, review, sanctioning and referral to the appropriate oversight agencies. Job Skills Physician,Medical Director,medical management program,HEDIS Job Responsibility Education/Experience: Medical Doctor or Doctor of Osteopathy, board certified in a specialty recognized by the American Board of Medical Specialists. Volunteer patient care required. Previous experience as Medical Director is preferred. Master’s degree in Business Administration, Public Health, Healthcare Administration or related field preferred. License/Certificates: Board Certification through American Board of Medical Specialists. Current state medical license without restrictions.

Keywords: KVR Consultant, Ames , Chief Medical Director - Des Moines, Other , Des Moines, Iowa

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Speech Language Pathologist (SLP) - Travel - Acute-150990
Description: RESPONSIBILITIES AND DUTIES Speech Language Pathologist SLP Provide treatment per facility, professional, and federal regulations and guidelines 40 hours guaranteed 9/23 start
Company: Delta Healthcare Providers
Location: Des Moines
Posted on: 10/16/2019

Dentist (DDS/DMD) - Dentist owned practice - Iowa-148945
Description: COMPENSATION AND BENEFITS Dentist DDS/DMD Guaranteed salary plus up to 35 of collections Student loan reimbursement available 401K plan Company Paid Liability Insurance, Health Benefits with
Company: Delta Physician Placement
Location: Des Moines
Posted on: 10/16/2019

Iowa - Associate Dentist Needed - $250k+-147843
Description: Location: Northeast Iowa Almost 100k local population and
Company: Delta Physician Placement
Location: Des Moines
Posted on: 10/16/2019


Recovery Support Specialist
Description: Position: Recovery Support Specialist Department: Integrated Health Home Status: Full Time Shift/Hours: Generally 8am-4:30pm, Monday-Friday
Company: Broadlawns Medical Center
Location: Des Moines
Posted on: 10/16/2019

Physical Therapist (PT) - Travel - Home Health-148951
Description: RESPONSIBILITIES AND DUTIES Physical Therapist Provide treatment per facility, professional, and federal regulations and guidelines 40 hours guaranteed
Company: Delta Healthcare Providers
Location: Des Moines
Posted on: 10/16/2019

Speech Language Pathologist (SLP) - Travel - Skilled Nursing Facility-152100
Description: RESPONSIBILITIES AND DUTIES Speech Language Pathologist SLP Provide treatment per facility, professional, and federal regulations and guidelines Long term acute care setting Looking
Company: Delta Healthcare Providers
Location: Des Moines
Posted on: 10/16/2019

Physical Therapist (PT) - Pediatrics - Missouri-149242
Description: Compensations and Benefits Physical Therapist PT 10,000 in Sign on Bonus 90 Days of Free Housing New Graduate Mentor Program 4-Day Work Week and 27 Days of PTO Company Paid Certifications and (more...)
Company: Delta Physician Placement
Location: Des Moines
Posted on: 10/16/2019

Occupational Therapist (OT) - Travel - Home Health-151978
Description: RESPONSIBILITIES AND DUTIES Occupational Therapist / Therapy Provide treatment per facility, professional, and federal regulations and guidelines 40 hours guaranteed
Company: Delta Healthcare Providers
Location: Des Moines
Posted on: 10/16/2019

Public Safety Officer
Description: Position: Public Safety Officer Department: Public Safety Status: PRN - Varies, as needed Shift: Varies Job Description: Completes regular tours
Company: Broadlawns Medical Center
Location: Des Moines
Posted on: 10/16/2019

Physician Assistant-Neurological Surgery - Barton Associates
Description: A hospital in Iowa is looking for a physician assistant of neurological
Company: Barton Associates
Location: Des Moines
Posted on: 10/16/2019

Log In or Create An Account

Get the latest Iowa jobs by following @recnetIA on Twitter!

Ames RSS job feeds