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POST DATE 8/16/2016
END DATE 12/19/2016
JOB DESCRIPTIONJudge 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