REMOTE - Medical Director for Managed Care Plans at Jefferson Health Plans

Thomas Jefferson University • Philadelphia, PA

1d • Remote

About The Position

Shape the future of healthcare delivery across one of the nation’s leading academic health systems. Jefferson Health is seeking a visionary Enterprise Medical Director to lead clinical strategy and utilization management for our integrated health plans and care management programs. This is a Full-Time Remote role.

Requirements

• Medical Physician (MD or DO) required.
• Pennsylvania Medical License without restriction.
• Board Certification in a specialty (primary care preferred)
• Minimum 5 years post-residency experience in the clinical practice of medicine.
• Managed care experience, with responsibility for utilization management.
• Excellent organizational, interpersonal, time management and communications skills.
• Strong leadership skills.
• Strong conflict resolution and independent decision-making skills.
• Expert project management ability.
• Strong influencing, negotiation and analytical skills.
• Working knowledge of PC based applications such as Excel, Access and Word.
• Knowledge of the principles of Utilization, Quality and Care Management.

Nice To Haves

• Graduate business degree is a plus (MBA, MMM, etc.).

Responsibilities

• Perform utilization review for requests for services including but not limited to inpatient, outpatient, pharmacy and dental. This will include peer-to-peer discussions with providers.
• Serve on and support the functions of committees including but not limited to the Utilization Management Committee and Pharmacy & Therapeutics Committee.
• Advise the HealthCare Senior Management team regarding the utilization of health care services and interventions to promote the effective delivery of medically necessary services.
• Participate and/or lead rounds including but not limited to disease management, care management or admissions.
• Provide support for Plan accreditation processes (NCQA), Utilization, Quality and Disease Management programs.
• Support ongoing activities in OB, pediatric, adolescent, adult preventative, and geriatric care.
• Develop and or revise practice guidelines for acute and chronic care.
• Develop and implement policies and procedures required to promote effective utilization management and achieve established targets.
• Collaborate with HealthCare Economics and Finance to continuously improve the collection and use of data describing resource utilization and outcomes.
• Represent HealthCare Management internally and externally at the direction of the VP Chief Medical Officer.
• Develop and implement work plans to optimize appropriate utilization and quality targets as directed by the VP Chief Medical Officer.
• Perform other job duties as assigned.

Benefits

• medical (including prescription)
• supplemental insurance
• dental
• vision
• life and AD&D insurance
• short- and long-term disability
• flexible spending accounts
• retirement plans
• tuition assistance
• voluntary benefits
• tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.

What This Job Offers

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