Our Healthcare Insurance client is seeking a Associate Medical Director to join their team for a contract to hire role!
Our client has over 5,000 employees and is the number 1 health insurer in the state of North Carolina, serving more than 3.89 million customers. Health care is changing, and our client is leading the way by providing innovative solutions that simplify the health care system, improve efficiency and outcomes, and help rein in costs. Our client is a not-for-profit with headquarters in Durham, NC.
Position: Associate Medical Director
Term: 6 Months, Contract to Hire
Location: Remote, USA
** While the position is Remote, work from home, to be eligible to convert to an employee of this company, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
- MD or DO from an accredited medical school Completion of residency training program in ABMS/AOA recognized clinical specialty.
- 3+ years of experience in related field.
- Board certified in medical specialty or equivalent certification consistent with level of clinical training Job
- Must have State of NC Licensure
- Able to rapidly review medical records, and synthesize information contained in them.
- Must be able to interface with multiple software platforms.
- Some interaction with the State Health Plan leadership to discuss utilization trends may be required.
- Have an understanding of quality improvement processes and the ability to interpret data on utilization and cost.
The Medical Director brings a unique set of knowledge and skills to the business and frequently serves as an interface between the company and physicians, providers, employer and community groups, and members as needed. Utilizes clinical knowledge and experience to support value-based strategies, clinical operations and our organizational pursuit of high quality and cost-effective care for members. The application of a Medical Directors knowledge and clinical skills will vary across the Health Care division, dependent on focus areas identified by the business area supported.
- Project planning and management
- Strategy: Develops, collaborates and/or drives strategy and approach for varied Health Care and/or organizational initiatives (i.e. sales management strategies, behavioral health strategies, new health care delivery strategies)
- Operations: Medical reimbursement and policy Care management (utilization management, case management, PA, appeals)Healthcare programs (disease management, Moonshots)Network support (Credentialing) Quality model design and analysis
- Partnership: Develop strategic partnerships with internal business partners and external clients to support value-based agreements and drive better consumer and provider experience. Takes a lead role in outreach and relationship building across the community (i.e. providers, health systems, community partners, members, etc).Evaluate and manage new and/or existing vendors and solution partners to align to the strategic direction Ongoing provider engagement functions Data gathering, management and analysis. Evaluate clinical and other data to identify opportunities for improvement in health outcomes and financial performance Discuss data and performance with providers, employers, accreditors and regulators as needed.
- Communications: Represent through delivery of presentations, speaking engagements and leadership of advisory groups with external audiences related to health care transformation and initiatives. Publish high impact content focused on improving accessibility, quality and affordability. Innovation Payment model design Identify market trends that should influence key investments (new technologies, best practices).Evaluation of investment/partnership opportunities