Executive Medical Director-Payment Integrity

HCSC•Richardson, TX

5d•Hybrid

About The Position

This position is responsible for assigned aspects of medical policies and programs. Performs medical reviews and interacts with the provider communities for assigned areas. Overseeing the annual budget and allocating resources for various projects and operational needs. Translating needs and initiatives into compelling business cases. Conducting cost-benefit analyses to justify investments and ensure ROI.

Requirements

Physician (M.D. or D.O) with a current and unrestricted physician license in a state or territory of the United States
Maintain Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of Osteopathic Specialists
5 years of post-graduate patient care/clinical experience.
5 years of managed care experience coupled with proven experience in the application of medical problems to managed care practices.
Knowledge of current medical and surgical techniques, reimbursement methodology, and benefit management.
Leadership skills to lead groups to consensus and resolution building aligned to corporate strategy
Demonstrated ability to independently make tough strategic decisions and move forward with actions on the strategies.
Strong verbal and written communication skills.
Experience achieving results through people.
Experience being proactive and highly results oriented; able to meet deadlines under pressure.
Experience thinking innovatively and developing process improvements to align with business strategies.
Experience being the subject matter expert/leader in a specified field.
Experience presenting and negotiating.
Strategic thinking skills.
Proficiency in computer use (including software applications such as Microsoft Office Product, Lotus Notes) needed for electronic documentation of case reviews

Nice To Haves

Experience developing business strategies, leading broad medical policy initiatives.
Legal/compliance experience
Payment integrity/ Reimbursement experience

Responsibilities

Performs medical reviews and interacts with the provider communities for assigned areas.
Overseeing the annual budget and allocating resources for various projects and operational needs.
Translating needs and initiatives into compelling business cases.
Conducting cost-benefit analyses to justify investments and ensure ROI.