MAXIMUS is a leading operator of government health and human services programs and has partnered with state, federal and local governments to provide critical, high quality health and human service programs to a diverse array of communities. Operating under MAXIMUS's founding mission of Helping Government Serve the People® since 1975, MAXIMUS Federal Services is entirely focused on helping government agencies run programs cost-effectively and serve program constituents with improved outcomes. By being a responsible steward for government programs, we help the federal government deliver on its promises through our people, process and technology. Our focus is always on outcomes and results that connect citizens more effectively with government services.
The Medical Director serves as the Qualified Independent Contractor (B-North) program's chief medical expert. The Medical Director is responsible for ensuring that clinical reviews adhere to the standards set forth in Medicare law and regulation, and in accordance with expectations set by the client and executive leadership. The Medical Director will be the program liaison to the client for all clinical matters, and will collaborate with other B-North leadership in the strategic oversight of the program.
REMOTE OPPORTUNITY - CONTINGENT UPON CONTRACT WIN OF CONTRACT
Essential Job Duties:
Directs the development of training materials for nurses and physicians
Oversee and review medical necessity determinations to ensure the consistency of decision-making by physician and other health care professions
Participate in meetings with client or other interested parties to discuss existing and newly developed coverage issues
Participate in peer review quality oversight of physicians and other health professionals who conduct determinations and perform re-review when necessary and provide feedback to reviewers
Supervise, schedule and manage internal physician team members
Participate in the recruitment, training and oversee members of internal and external contracted clinical personnel
Develop and implement processes resulting in high production while maintaining high quality for utilization and medical necessity review
Contributes clinical expertise for the development of new business
Performs other duties as may be assigned by management
Education and Experience Requirements:
Doctor of Medicine or Osteopathy currently licensed in a US State, with Board certification in one of more specialties recognized by the ABMS (American Board of Medical Specialties) or AOBM (American Osteopathic Board of Medicine). Primary care experience preferred
At least five (5) years, post Board certification, experience in direct patient care, following the completion of a residency program, required
Ability to pass stringent credentialing based upon URAC/NCQA type standards
Knowledge of Medicare programs, particularly coverage and payment rules
At least two (2) years' experience in a management role with oversight of quality assurance or medical management functions, including "evidence based medicine" research or application, strongly preferred
Technology experience with programs, i.e., Microsoft Office (Word and Excel) and ability to research utilizing the internet preferred, including web based portals
The preferred candidate will have two (2) or more years' experience as a Medical Director for a Medicare Contractor (e.g., Fiscal Intermediary, Carrier, etc.) or health insurance company and intimate knowledge of Medicare coverage and reimbursement policies, and related issues
Demonstrates teamwork and promotes positive company relations
Excellent organizational, interpersonal, written, and verbal communication skills required
Ability to work as a team member in a fast-paced, deadline-oriented work environment
Ability to successfully execute many complex tasks simultaneously
A committed and diverse workforce is our most important resource.
MAXIMUS is and Affirmative Action/Equal Opportunity Employer.
MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status. - provided by Dice Part B Medical Director (Remote Opportunity)