Medical Director
Current➤ Ensuring ongoing development/implementation of policies that guide and support provision of medical staff services.➤ Serving as the primary liaison between the Administration and medical staff, working to achieve quality outcomes.➤ Developing and implementing medical management strategic plans for the market, while aligning with matrix partners.➤ Stabilizing, improving, and educating Primary Care Physician & Specialty networks, and monitoring practice patterns.➤ Recommending corrective actions as needed to ensure that the care provided meets the standards for acceptable care.➤ Ensuring medical decisions are rendered by qualified personnel, not influenced by fiscal or administrative concerns.➤ Participating in quality processes such as audits, inter-rater reliability, clinical reviews, as well as quality projects.➤ Focusing on service and cost optimization, including evaluating and implementing new technologies and treatments.➤ Maintaining a working knowledge of applicable national, State, local laws and regulatory requirements affecting staff.➤ Achieving internal customer satisfaction and accreditation compliance goals by assuring timely turnaround of reviews.➤ Serving as a mentor and coach to other Medical Directors and colleagues around QA and performance improvement.➤ Attending or chairing committees, such as Credentialing, P&T, and others as directed by the Chief Medical Officer.➤ Interacting with network and group providers and Medical Managers regarding practices and resource management.➤ Conducting retrospective reviews of claims and appeals, and resolving grievances related to medical quality of care.➤ Monitoring services through continuum among hospitals, skilled nursing facilities, home care to ensure cost-efficiency.
