Medical Director

Medical Director - Homestead, FL 33032

Compensation: $165k

Overview: Nexus HR is looking for a passionate and dedicated Medical Director who actively seeks new ways of exceeding the expectations of patients, families, caregivers, support persons, and co-workers, for a reputable medical center in Homestead, Florida.

Client-highlighted qualifications - 5 to 8 years of medical experience, with at least 2 years of medical directorship experience, a medical license in Florida, a strong foundation in primary care and geriatric care

About the Job

The Medical Director will provide medical and clinical oversight and maintain the medical management to ensure quality healthcare is provided

Duties and Responsibilities:

• Monitoring the level of care using both statistical information and chart review and may offer unsolicited medical judgment when appropriate

• Monitoring the use of medical services, and has the authority to issue denials of service deemed appropriate

• Oversees Utilization Management Programs and may oversee Quality Improvement Programs

• Oversee, implement, and constantly update utilization management policies for referrals and medications for cost-effectiveness.

• Serves as a clinical resource for senior administrative management and case managers.

• Assists in the development and implementation of “best practice patterns” in the form of both medical protocols and process management protocols

• Participates in the review and assessment, and provides advice on complex, controversial, and/or unique claims that are outside the realm of medical policy, including solicitation and evaluation of advice from outside medical consults and physicians concerning complex, controversial, experimental and/or innovative techniques

• Provides medical expertise and support to ensure appropriate care and services through a continuum between hospitals, skilled nursing facilities, and home care to ensure quality and continuity of care for complex case management

• Facilitate conformance with DHS, DMHC, NCQA, and other regulatory requirements

• Evaluate referral authorization requests in support of nurse reviewers and manage the denial process

• Teaching and administration of charts review for Family Nurse Practitioners and Physician Assistants.

• Supervises, advises and trains clinical professionals and/or students in areas of expertise.

Qualifications:

• At least three (3) years of experience as a Medical Doctor

• At least 10 years of experience as a medical provider

• Board Certified Family Practice / Internal Medicine Physician

• ACLS or CPR / AED Certified

• Current medical license to practice, without restrictions, in Florida

• Education, training, or experience related to NCQA, QM, multi-specialty group practice, and HMO industry

• Broad knowledge base regarding managed care systems, quality improvement, medical utilization, and risk management

• Must be analytical, results-oriented, able to establish priorities, and respond to requests for assistance, guidance, or decision-making on time

• Preferably free from any insurance exclusivity agreement.

• Experience in EMR/EHR is highly preferred

• Able to work in Homestead, FL

• Bilingual (English/Spanish) is highly preferred.