Medical Director Job In Rancho Cordova, California
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Actively interfaces with providers (hospitals, PPG’s, IPA’s) to improve health care outcomes, health care service utilization and costs.
Analyzes member and population data to guide and manage program direction such as ensuring that members enroll in clinical programs indicated by their clinical need.
Leads and/or supports resolution of member or provider grievances and appeals
Optimizes utilization of medical resources to maximize benefits for the member while supporting Health Net Plans and Health Net corporate initiatives.
Collaborates with Provider Network Management on the network strategy and may meet with Provider Network Management to ensure effective execution of the strategy.
Assists in the analysis of performance data from physicians and hospitals and the development and implementation of a corrective action plan.
Works to ensure/support the appropriate implementation of policies and procedures to maintain compliance with accreditation and regulatory agencies.
Supports state regulatory relationships and may serve as the lead physician for state and federal medical management regulatory audits (i.e., NCQA, HEDIS, URAC).
Actively supports Quality and Compliance to ensure that Health Net meets and exceeds medical management, regulatory, agency, and quality standards.
Provides effective and active medical management leadership.
Serves on quality and care management teams and committees.
Education/Experience: Graduate of an accredited medical school; Doctorate degree in medicine. Minimum five years psychiatric practice after completing residency-training requirements for board eligibility in Psychiatry. Minimum three years medical management experience in a managed care environment.
License/Certification: Board certification by the ABMS or AOA in Psychiatry. Unrestricted active MD license in the State of practicing and credentialed by the health plan of employment.