This is an exceptional opportunity to do innovative work with the fastest growing division within a Fortune 50 organization. Transform care - build innovative care programs.
This is a 100% Remote Role - live anywhere but requires an active Louisiana MD license and strong Utilization Management background.
Reporting into the CMO, the ideal candidate will be responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical management staff.
- Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.
- Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
- Identifies and develops opportunities for innovation to increase effectiveness and quality.
- Serves as a resource and consultant to other areas of the company, may chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees, conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, provides guidance for clinical operational aspects of the program.
- Supports the medical management staff ensuring timely and consistent responses to members and providers.
M.D. or D.O.
-Must possess an active, unrestricted license to practice medicine issued by the State of LA (can reactivate a lapsed license or obtain one before the employment start date)
Current Board certification by the American Board of Psychiatry and Neurology in Psychiatry
-10 years of clinical experience or any combination of education and experience, which would provide an equivalent background
-Utilization Management, Medical Leadership or Managed Care background is a plus.