Service Medical Director leading Anaesthesia and Perioperative Medicine at Monash Health. Collaborating across departments to ensure effective healthcare delivery and patient safety standards.
About the role
- Administration of physical and/or behavioral health medical services to ensure appropriate and cost-effective medical care.
- Develop and implement programs to improve quality, cost, and outcomes.
- Provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations.
- Identify cost of care opportunities and serve as a resource to staff including Medical Director Associates.
- Support clinicians to ensure timely and consistent responses to members and providers and provide guidance for clinical operational aspects of a program.
- Conduct peer-to-peer clinical reviews and peer-to-peer clinical appeal case reviews with attending physicians or other providers to discuss review determinations.
- Represent the company to external entities and/or serve on internal and/or external committees; may chair company committees.
- Interpret medical policies and clinical guidelines and develop/propose new medical policies.
- Lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality, cost and outcomes; identify opportunities for innovation.
- Program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities.
Requirements
- Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
- Must possess an active unrestricted medical license to practice medicine or a health profession.
- Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
- A minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- For Health Solutions and Carelon organizations (including behavioral health) only, a minimum of 5 years of experience providing health care is required.
- 1-2 years Utilization Management experience strongly preferred.
- Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
- Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
- May require COVID-19 and Influenza vaccination for certain patient/member-facing roles.
Benefits
- market-competitive total rewards including merit increases
- Paid holidays
- Paid Time Off
- incentive bonus programs (unless covered by a collective bargaining agreement)
- medical, dental, vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs and financial education resources
- work virtually full-time (except required in-person training sessions) and Hybrid Workforce Strategy options
- professional and career development opportunities
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
AS
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