Medical Director Job In Rancho Cordova, California
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· Education/Experience: Graduate of an accredited medical school; Doctorate degree in medicine. Minimum five years medical practice after completing residency-training requirements for board eligibility. Minimum three years medical management experience in a managed care environment. Military Health System experience preferred.
· Board certification in an ABMS recognized specialty.
· Unrestricted active MD license in the State of practicing and credentialed by the health plan of employment
· Government Security/Clearance/Citizenship Requirements:
Requires US citizenship and current security clearance
- Position Purpose: The Medical Director Provider Engagement works actively to implement and administer medical policies, to support disease and medical care management programs, and to integrate physician services, quality assurance, appeals and grievances, and regulatory compliance programs with medical service and delivery systems to ensure the best possible quality health care for Health Net Federal Services (HNFS) federal program Beneficiaries through the engagement of perspective, and participating providers with performance data and improvement strategies and peer-to-peer education on TRICARE program policy and changes. The Medical Director assists the Chief Medical Officer and Senior Medical Director by providing collaborative input and recommendations to various departments within the organization as to policies and procedures that impact the delivery of medical care through provider performance.
- Supports the HNFS Chief Medical Officer and/or the Sr Medical Director for Medical Policy and Utilization Management through provider interface. Participates in the effective operational management of the federal health program medical management team with an emphasis on execution, outcomes, continual improvement, and performance enhancement.
- Works closely with analytics, PNM, and CQM to identify and prioritize provider entities for targeted engagement.
- As a principal representative of HNFS provides clinical liaison to and maintains relationships with network providers, provider groups, facilities, and health systems. Participates in quality improvement programs to assure that federal health program beneficiaries receive timely, appropriate, and accessible health care.
- Provides ongoing compliance with standardized systems, policies, programs, procedures, and workflows.