Medical Director 8/16/2016

Confidential Company Manchester, NH

Company
Confidential Company
Job Classification
Full Time
Company Ref #
28778607
AJE Ref #
575898449
Location
Manchester, NH
Job Type
Regular

JOB DESCRIPTION

APPLY
Judge Healthcare is actively seeking a MEDICAL DIRECTOR for a health plan located in the MANCHESTER, NH area.

THIS OPPORTUNITY IS FULL TIME AND PERMANENT.

THIS JOB WILL HAVE THE FOLLOWING RESPONSIBILITIES:

* Will be responsible to support the staff for the Clinical Affairs Office
* Responsible for medical management including: utilization review, population management, concurrent review, credentialing, quality, appeals and grievances, pharmacy management and network management.
* Conduct clinical review of appeals and grievances.
* Provide clinical case review and consultation for all utilization management activities.
* Develop and maintain relationships with government organizations, regulatory groups, healthcare providers, and external stakeholders.
* Represents the Chief Medical Officer in Massachusetts, New Hampshire and other locations as needed.

QUALIFICATIONS & REQUIREMENTS:

* Minimum 5years clinical experience
* Minimum 3years experience in medical management
* Direct experience in a managed care setting
* Board certification in recognized medical specialty
* Current/unrestricted license as an MD
* Extensive knowledge in accreditation/NCQA guidelines
* Knowledge of federal and state Medicaid regulations
* Comprehensive knowledge of InterQual