Obstetrics & Gynecology Physician
OneStaff Locums
Dallas, TX, 75201, USA
Dallas, TX, 75201, USA
- Healthcare
- Full-time
- Obstetrics and Gynecology
- Associate Medical Director
- Managed Care
The Associate Medical Director in Obstetrics & Gynecology oversees clinical activities and supports the delivery of comprehensive care within a managed care environment. Responsibilities include utilization management, provider performance review, coordination between medical and pharmacy benefits, and participation in policy development and committee leadership. The role requires strong leadership, knowledge of managed care principles, and collaboration with state and local healthcare bodies.
Associate Medical Director with OB/GYN Specialty needed in Dallas, TX! Fully REMOTE as locums, hybrid model as perm!
"The Associate Medical Director will take a hands on approach in overseeing and supporting clinical activities, ensuring the delivery of comprehensive care to hospital members."
13-week assignment with hopes that the provider will transition into a permanent role.
Schedule: Monday-Friday 8am-5pm
Start: Pending Credentialing
Responsibilities:
"The Associate Medical Director will take a hands on approach in overseeing and supporting clinical activities, ensuring the delivery of comprehensive care to hospital members."
13-week assignment with hopes that the provider will transition into a permanent role.
Schedule: Monday-Friday 8am-5pm
Start: Pending Credentialing
Responsibilities:
- Reviews prior authorization and appeals request for approval or denial of claims payment based on medical necessity.
- Performs peer to peer calls as necessary to support the utilization management process.
- Provides clinical oversight for utilization management, disease management and quality management activities as assigned by the PCHP Chief Medical Officer or Sr. Medical Director including participation in development of medical policies and procedures for coverage and authorization and clinical standards and guidelines based on evidence-based medicine.
- Analyzes data to establish health care provider profiles and define acceptability of physician performance, conducts review of provider applications and qualifications, and participates in the review process of providers who fail to meet required standards, site and medical record reviews, as appropriate, to ensure adherence to managed care and PCHP policies.
- Assists the Sr. Medical Director and the Pharmacy Director of PCHP in overseeing and administering the pharmacy benefit for PCHP members including coordination of care between the Medical and Pharmacy benefits.
- Assists the Sr. Medical Director in oversight, evaluation, and administration of the clinical aspects of PCHP fraud, waste and abuse programs.
- Participates in development, implementation, and monitoring of annual goals and objectives for PCHP that support the mission and objectives of Parkland.
- Assists in identifying member and provider needs for education and health promotion. Participates in assessment of existing education programs offered to providers, developing and evaluating such programs, as required, to ensure that managed care service area and PCHP needs are appropriately served.
- As assigned by the Chief Medical Officer or Senior Medical Director assists in representing PCHP on clinical activities with relevant State and local bodies such as the Texas Department of Insurance, Texas Health and Human Services Commission, and Texas Medical Association.
- Participates in identification and analysis of process improvement of jobs design, work processes, and work flows for the clinical area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the managed care delivery system and PCHP.
- As assigned by the Chief Medical Officer or Sr. Medical Director, serves as chairperson or member of managed care committees, and participates on various community and interdisciplinary committees.
- Must be philosophically oriented to the managed care concept of health delivery.
- Must have a working knowledge of managed care principles.
- Must demonstrate strong leadership, organizational, interpersonal, and verbal skills including demonstrated ability to work efficiently and communicate with executive management, physicians groups, community and provider organizations, and persons of diverse socioeconomic backgrounds.
- Must be able to demonstrate a working knowledge of Texas Medicaid Regulations and their interpretation.
- Must demonstrate effective supervisory, administrative and management skills including computer literacy.
- Must be able to demonstrate patient centered/patient valued behaviors.
- Must understand and demonstrate knowledge of principles of care coordination and collaboration, population health and social determinants of health, clinical evaluation of evidence based care and value based purchasing.
- Must be familiar with the role of pharmacy and behavioral health in managing health care.
- Ability to create, review and interpret treatment plans.
- Ability to adapt to changing priorities.
- Demonstrated ability to deal with confidential information.
- Demonstrated negotiation skills.
- Ability to remain calm under pressure.
- Ability to apply medical knowledge and principles to business challenges, achieving significant member, business, and quality outcomes.
- Ability to be detail-oriented and have a "hands-on" approach.
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