Summary for Medical Director:
Functions as Senior Physician Executive responsible for clinical activities of company in Denver, Colorado. Provides clinical leadership to the strategic, operational, and quality issues of any of Utilization Management contract. Responsible for contract’s clinical policies and decisions. Seeks strategic opportunities and relationships in fulfillment of mission. Ensures that all functions of the medical department are carried out in a manner that meets the needs of the company. Provides supervision and training for physician review panel. Maintains second level review panel at level and specificity to support contract needs. Serves a key leadership role in directing and communicating mission and vision to both internal and external audiences.
Benefits for Medical Director:
Compensation: 225K - 250K
Bonus: Annual merit-based review
Benefits: 5K for CME, health (vision/dental), malpractice, PTO, PLI and vacation
Hours: 8-hour days, flexible, works from office 3 days a week and 2 days from home
Responsibilities for Medical Director:
• Oversee all clinical and medical aspects of the IHRP in compliance with federal and state law and requirements of the Contract.
• Attend by phone and function as a subject matter expert at all IHRP activities related to IHRP Client Appeals with an Administrative Law Judge presiding, or IHRP Provider Appeals with the Attorney General’s Office. With prior, written, approval of the Department, the Contractor may substitute a subject matter expert in place of the IHRP Medical Director at any hearing before an Administrative Law Judge or the Attorney General’s Office.
• In the event that the IHRP Medical Director is unable to attend a hearing, the Contractor shall ensure that another physician attends in the IHRP Medical Director’s place with prior approval of the Department.
• The Medical Director or approved subject matter expert shall review all documentation pertaining to the hearing prior to the hearing in order to be able to respond to issues relating to that documentation.
Qualifications for Medical Director:
• Degree of Doctor of Medicine or Doctor of Osteopathy and be licensed to practice medicine in the state of Colorado
• Minimum of seven (7) years of postgraduate experience in clinical practice.
• A minimum two (2) years’ experience in state Medicaid programs with a focus on clinical care processes and outcomes, clinical guidelines, medical economics research, particularly the evaluation of medical utilization, hospital inpatient reviews, population-based care practices and Provider billing practices.
• Experience serving medically underserved populations
• Experience creating and editing clinical guidelines and providing clinical recommendations to care management firms, cost management firms, insurance carriers, primary care medical homes, or accountable care organizations
• Experience in Medicaid or Medicare plans, or related health plans.
• Experience evaluating evidence-based studies including review of the quality of the evidence. This includes assessing comparative evidence on items such as medical devices, durable medical equipment, medications, and/or other treatments
• Experience evaluating new or modified codes such as the Healthcare Common Procedure Coding System (HCPCS).
• Demonstrated success working in a managed care environment including experience in health maintenance and preventive care; anticipatory guidance and health education; acute and chronic illness care; coordination of medications, specialists, and therapies, and provider participation in hospital care.