Associate Medical Director with Family Medicine 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
Job 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 Hospital 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 Hospital policies.
- Assists the Sr. Medical Director and the Pharmacy Director of Hospital in overseeing and administering the pharmacy benefit for Hospital 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 Hospital fraud, waste and abuse programs.
- Participates in development, implementation, and monitoring of annual goals and objectives for Hospital that support the mission and objectives of the Hospital.
- 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 Hospital needs are appropriately served.
- As assigned by the Chief Medical Officer or Senior Medical Director assists in representing Hospital 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 the Hospital.
- 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.
