Our Values

Careers


Medical Director

    • Job Tracking ID: 512689-653066
    • Job Location: Milwaukee, WI
    • Job Level: Sr. Executive
    • Level of Education: Doctoral Degree
    • Job Type: Full-Time/Regular
    • Date Updated: October 11, 2018
    • Years of Experience: More Than 15 Years
    • Starting Date: ASAP
Invite a friend
facebook LinkedIn Twitter Email


Job Description:

Do you feel 'called' to do your part to improve the lives of others, to lead change in how health care for the neediest of our society is managed, to share your skills and talents with others who want to do the same with you?

iCare is looking for a dynamic Medical Director to join our leadership team. This position is responsible for oversight of the utilization management, prior authorization, credentialing review, and support for the appeals and grievances process. Provides medical expertise and acts as senior medical resource for review of complex medical and social cases. Acts as primary liaison with physicians

  1. Assist in the development of ongoing quality improvement of iCare services, i.e., credential reviews, quality improvement programs, disease management and member satisfaction programs.
  2. Assist iCare to achieve its principal programmatic goals — coordinating medical, behavioral health and social services, improving access, and maximizing resources.
  3. Assist in development of outcome measures to evaluate the effectiveness of the iCare care coordination model and conduct ongoing monitoring of the model’s effectiveness, to include recommendations for changes and improvements consistent with organizational goals and budgetary constraints.
  4. Assist in designing and implementing programs that promote health and reduce the risk and/or onset of illness.
  5. Assist in selecting and disseminating treatment guidelines as required by State Contract or CMS Contract.
  6. Work in conjunction with legal counsel and senior management on potentially litigious utilization or case management issues.
  7. Assist in the design of policies and programs for iCare to achieve measurable levels of effectiveness, efficiency, and customer and provider satisfaction.
  8. Participate in the review and approval of authorization activities for medical review purposes. Assume responsibility for approving or denying cases for medical necessity and/or clinical appropriateness.
  9. Guide selection and interpretation of utilization review criteria.
  10. Ensure the clinical decision management and provider profiling support tools are effective, current and credible.
  11. Work in conjunction with senior management and various committees to determine strategy and management direction for utilization management, quality management and credentialing initiatives.
  12. Develop a panel of independent (non-participating and participating) physician advisors to cover the need for specialty-matched peer reviews as needed.
  13. Represent iCare in external professional settings, meetings, conferences, etc.
  14. Contribute to the development of policies, procedures and programming to support compliance with the State contract and CMS contract and efficiencies within the organization.
  15. Assist Network Development/Provider Relations in an advisory capacity.
  16. Assist in efforts to maximize financial reimbursement to the company through projects such as HCC scores, vent reviews, identifying cases for subrogation.
  17. Supervise and support the Pharmacy Department Director and staff regarding Part D HEDIS and Medicaid P4P measures, third party vendor interventions and contracts, and assistance in Medicare Part D contract bid preparations and submissions.

Experience and Skills:

1. Current non-restricted license to practice medicine in the State of Wisconsin.

2. Board certification in specialty approved by the American Board of Medical Specialists.

3. Knowledge of and experience with managed health care.

4. Well-developed supervisory, problem solving and interpersonal communication skills.

5. Knowledge of and familiarity with Medicare and Medicaid programs.

6. Knowledge of and experience with Quality Assurance Programs.

7. Knowledge of software programs, Excel, Access, Word Outlook.

DESIRABLE QUALIFICATIONS:

1. Experience in managing chronically ill population.

2. Experience in managing behavioral health issues.

3. Previous supervisory/management experience.

4. Ability to identify and resolve problems.

5. Ability to communicate ideas/concepts in one-on-one situations, as well as in/before groups.

6. Effective and professional oral and written communicator.

7. Ability to analyze and extrapolate financial and statistical data using Access/Sequel, MID Office products and other database/spreadsheet capabilities.


 

 
 
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
  • All content and images unless otherwise indicated are
  • Copyright © 2017 Independent Care Health Plan