CareBridge-posted 3 months ago
$250,236 - $411,102/Yr
Full-time • Senior
Metairie, LA
251-500 employees
Ambulatory Health Care Services

The National Accounts Medical Director is responsible for serving as the Operational Medical Director for our care management models for our National Account clients. The medical director will be responsible for supporting the clinical vision and implementation to deliver an improvement in the health of the people we serve. The medical director supports product strategy/design and medical management approaches that impact health care quality, cost, and outcomes, and improving access to the health improvement tools offered to clients/ members. The medical director provides clinical expertise in sales planning and participates in the acquisition and retention of clients for National business as needed. Provides input on the clinical relevance to account reporting regarding use of medical services by members. Involved in identifying and managing medical utilization trends, emerging trends and market changes that impact the client and members. Responsible for proactively identifying and solutioning with account management, Sales RVP Medical Directors.

  • Provides clinical oversight for Utilization Management, Case Management, and Total Population Health of the Clinical Team.
  • Conducts case reviews for both utilization and case management issues.
  • Ensures consistent adoption and implementation of all medical policies.
  • Leads multidisciplinary rounds.
  • Performs peer-to-peer outreach for both UM and CM issues, identifying quality issues.
  • Conducts clinical report reviews, trend management, benefit design consultation, and supports overall clinical performance guarantee success.
  • Supports all state specific requirements that apply for each state where there is business.
  • Requires MD or DO and Board certification approved by one of the following certifying boards: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
  • Must possess an active unrestricted medical license to practice medicine or a health profession.
  • Must be located in a state or territory of the United States when conducting utilization review or an appeals consideration.
  • Minimum of 10 years of clinical experience; or any combination of education and experience that provides an equivalent background.
  • For Health Solutions and Carelon organizations, minimum of 5 years of experience providing health care is required.
  • Indiana MD license or compact state multi-licensure is preferred.
  • Board certification preferably in a Primary Health Specialty, Family or Internal medicine or Surgery.
  • Knowledge and experience with population or segment health management is a plus.
  • Knowledge of the health insurance industry and the National Accounts segment is preferred.
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
  • Paid Time Off
  • Medical, dental, vision benefits
  • Short and long term disability benefits
  • Life insurance
  • Wellness programs
  • Financial education resources
© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service