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Medical Director of Clinical Performance

PWW Recruiting, LLC.

Medical Director of Clinical Performance

Southfield, MI
Paid
  • Responsibilities

    Reporting to the VP for Medicare

    STARs and Clinical Performance, the Medical Director, Clinical Performance is a Senior level role responsible for providing medical leadership over the Senior Health Services team’s development and execution of utilization management and care management initiatives. This role will also assist in the development of medical policy and claims payment policy.

    OVERALL DUTIES:

    • Leads and actively in the identification, evaluation, and selection of program, utilization management, and claims editing vendors;

    • Identifies key improvement areas and in result-driven program development across the business unit;

    • Reviews quantitative and qualitative data in developing plans to achieve goals;

    • Responsible for balancing workload to optimize the effectiveness of the department;

    • Provides leadership, planning, project coordination and management for the development of a cost-effective department while concurrently facilitating efficient operations to meet current and future business needs within the organization;

    • Represents Senior Health Services in community and industry programs and conferences;

    • Upon request, functions as the department head in the absence of the executive leader;

    • Performs other work-related duties and responsibilities as directed, assigned or requested.

    EMPLOYMENT QUALIFICATIONS: EDUCATION: -Medical Doctor Degree (MD) or Doctor of Osteopathic Medicine (DO) required. -Advance degree, such as MBA, MHA, MPH, MMM, or a related field preferred. -Board Certified in in a specialty approved by the American Board of Medical Specialists or the American Board of Osteopathy. -Current unrestricted state of Michigan Doctor of Medicine (M.D.) or doctor of osteopathy (D.O.) license. -. -Certification or progress toward certification and encouraged.

    EXPERIENCE: -Ten (10) years of progressively more responsible experience in a healthcare environment with technical experience that provides the knowledge, skills and abilities. -Five (5) years management or supervisory experience in healthcare strongly preferred. -Medicare Advantage revenue experience strongly preferred. -Health care practice experience providing services to Medicare Advantage and Medicaid patients required. -Broad experience of the Medicare segment and an understanding of the overall Medicare stars program.