Executive Medical Director-Payment Integrity

Health Care Service Corporation • Tulsa, OK

7d • $214,800 - $398,900 • 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.

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

• 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.

Benefits

• health and wellness benefits
• 401(k) savings plan
• pension plan
• paid time off
• paid parental leave
• disability insurance
• supplemental life insurance
• employee assistance program
• paid holidays
• tuition reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Education Level: Ph.D. or professional degree