Medical Director – Medicaid

Job #: 1092144

Coventry Health Care

Sunrise, Florida

Oversees the medical management programs for Medicaid in State & Florida.

Provides medical leadership to ensure excellent quality of care and service is provided to our members/clients that is efficient and cost effective.

Essential Responsibilities:
• Provided technical expertise in medical management by direct decision making in the areas of pre-authorization, concurrent review of hospitalized patients, discharge planning, complex case and chronic care management and credentialing.
• Oversees the clinical aspects of the quality management, credentialing, pharmacy and medical management program.
• Chairs (or staffs) all peer-review committees such as Quality Improvement, Pharmacy and Therapeutics, Credentialing and others that are deemed appropriate for the health plan. May participate in the Physicians Advisory Committee and consult periodically with peers in the field.
• Analyzes medical cost drivers and develops specific plans to reduce excessive cost.
• Works with senior leadership to develop strategic approached to improve company performance and expand growth by optimizing provider network, evaluating provider (hospital, physician, ancillary) contracts, and developing other creative approaches.
• Provides oversight for all quality improvement projects.
• Provides oversight for all accreditation activities (URAC and/or NCQA) within the assigned business sector.
• For Medical Directors with senior clinical staff responsibilities, ensures a staff of qualified clinicians accountable to the organization for decisions affecting consumers is maintained, and that appeals are reviewed by non-subordinate Board Certified specialists.
• Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
• Performs other duties as required.

Job Specifications:
• Formal education including an MD or DO degree
• Employee must hold and maintain an unrestricted license to practice medicine.
• Board certified with post residency experience preferably in primary care specialty.
• Board Certification may be waived for a part-time Medical Director who will not function in the capacity of a senior clinical staff person.
• Previous (2 years) managed care experience as a Medical Director with Medical experience.
• Excellent clinical knowledge and skills.
• Strong written and verbal communication skills.

Coventry Health Care
Bethesda, MD
301-581-0600