evry-health - Evry Health - Medical Director for Health Plan (Full-time or Part-time)
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Requirements
• Active, unrestricted Texas (TX) medical license without limitations or sanctions • Doctor of Medicine (MD) with 8+ years of clinical experience; management experience preferred • Board certification in a specialty recognized by the American Board of Medical Specialties • Experience working within a health insurance plan, with an emphasis on population health • Experience in managed care and utilization management, including performing utilization reviews within a health plan • Strong knowledge of managed care systems, quality improvement, and clinical best practices • Experience with MCG or other clinical guidelines • This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas. • Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones. This position requires work during the stated business hours. • Required to have a dedicated work area established that is separate from other living areas and provides information privacy. • Ability to keep all company sensitive documents secure. • Must live in a location that receives an existing high-speed internet connection/service.
Responsibilities
• Lead utilization management strategy, including oversight of medical necessity determinations and review processes • Own medical policy development, incorporating regulatory updates and care guideline changes • Lead and Partner with the Utilization Management Review Committee • Provide medical oversight, expertise, and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members • Promote positive relations with the local medical community, including periodic consultation with providers, facilities, caregivers, etc. • Review case management data to identify trends, gaps in care, and recommend corrective actions • Provide oversight and direction for staff and provider training and education • Integrate clinical quality and best clinical practices into medical management program development • Evaluate the development of new programs and the continuation of existing programs • Investigate future care management and patient engagement technologies and evaluate their impact on providers’ practices, patient safety, and patient experience
Benefits
• Comprehensive health, dental, and vision insurance as well as life and disability • Retirement savings plan with company match • Generous time off/vacation • Professional development opportunities • Flexible and remote work environment
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