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Associate Medical Director

Company: Affinity Management Group
Location: Fort Smith
Posted on: March 24, 2020

Job Description:

Exciting Direct Hire Opportunity! Our Client in Fort Smith, Arkansas has an immediate need for as Associate Medical Director. - This role requires you to work 2, 3 or 4 days per week. In this role you will be responsible for the overseeing of physician advisor reviews for private and Medicaid contracts and perform initial and/or reconsideration reviews as necessary and developing relationships and promoting mutually beneficial partnerships with employees, clients, key stakeholders, constituents, other healthcare organizations and the community at large. Responsibilities: Responsible for oversight of physician advisor reviews for all private and Medicaid contracts and performs initial and/or reconsideration reviews as necessary: Perform ongoing quality assurance/improvement for physician advisor reviews Correction of mistakes in physician advisor review Education of current physician advisors Train new physician advisors Facilitate mission goals across teams at the organizational level. Meet regularly with the Medical Director to stay informed, to offer direction and support for inter-departmental projects and to confer on organizational goals, objectives and policies. Confer with the Medical Director and management to identify and develop new opportunities for expanding the business. Monitor current contracts and clients to identify and establish "new business" - goals and revenue growth opportunities. Contribute and edit scientific articles, which will be submitted to medical, epidemiology, or statistical journals. Annually evaluate and update, if necessary, all clinical review criteria. Review pertinent medical record and represent the details of the rationale provided by external physician reviewers and willingness to provide testimony based on that review in an open court proceeding (i.e. fair hearing). Fair hearings could require an in-person appearance if requested. Function as a resource for clinical and non-clinical staff by providing oversight and follow-up for clinical related questions or issues. Provide support to initial clinical reviewers. Select, direct, coach and evaluate assigned staff. Develop standards of staff performance and set annual performance objectives. Ensure the quality and accuracy of employees' work product and that staff meet performance goals within designated time frame. Participate in peer-to-peer clinical review phone conversations, as necessary, to meet contractual obligations. Ensure compliance with company policy, contractual obligations, state and federal laws and regulations. Maintain current knowledge of corporate contracts with emphasis on opportunities for new business. Attend Board Meetings upon CEO request. - Adhere to format, content and style guidelines, giving consideration to usability and ensuring accuracy, consistency and quality. Follow company, state and federal protocols regarding data confidentiality/security and HIPAA compliance. Meet regularly with assigned staff to communicate pertinent information, needs and requests to other team members as appropriate. Train assigned staff on job specific regulations and contract requirements. Qualifications: Current unrestricted clinical license in the state of Arkansas as a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO). Must be Board certified (current Board certification may be waived if only performing initial reviews). Master's degree in public health, healthcare administration, or business administration a plus. Five years of experience as a practicing physician. Must be a practicing physician involved in direct patient care. Two years of experience in medical review, quality improvement or health care management. Experience in providing professional testimony in a legal setting. Experience and knowledge of Medicaid and other major managed health care programs. - Ability to lead and participate in multi-disciplinary team projects involving professional personnel from several fields. Ability to manage and direct the work of outside consultants, outsourced services and other external entities. Well-developed planning, organizational development and business skills " -Ability to build and manage partnerships and relationships with a variety of stakeholders required. Strong detail orientation, organizational and project management skills evidencing an ability to respond to multiple projects simultaneously with appropriate sensitivity and tact including the ability to manage through conflict. Knowledge of ICD-9/ICD-10 Coding, HIT/HER and Medical terminology. For more information or immediate consideration, please email resume directly to .

Keywords: Affinity Management Group, Fort Smith , Associate Medical Director, Executive , Fort Smith, Arkansas

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