Physician / Emergency Medicine / Texas / Permanent / Internal Medicine
Company: Murdock Consulting
Location: Houston
Posted on: February 24, 2021
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Job Description:
Physician / Internal Medicine: Medical Director / Houston,
TX
Assist the Chief Medical Director to direct & coordinate the
medical management, quality improvement and credentialing functions
for the business unit. Provides medical leadership of all for
utilization management, cost containment, and medical quality
improvement activities. Performs medical review activities
pertaining to utilization review, quality assurance, and medical
review of complex, controversial, or experimental medical services.
Supports effective implementation of performance improvement
initiatives for capitated providers. Assists Chief Medical Director
in planning and establishing goals and policies to improve quality
and cost-effectiveness of care and service for members. Provides
medical expertise in the operation of approved quality improvement
and utilization management programs in accordance with regulatory,
state, corporate, and accreditation requirements. Assists the Chief
Medical Director in the functioning of the physician committees
including committee structure, processes, and membership. Oversees
the activities of physician advisors. Utilizes the services of
medical and pharmacy consultants for reviewing complex cases and
medical necessity appeals. Participates in provider network
development and new market expansion as appropriate. Assists in the
development and implementation of physician education with respect
to clinical issues and policies.Identifies utilization review
studies and evaluates adverse trends in utilization of medical
services, unusual provider practice patterns, and adequacy of
benefit/payment components. Identifies clinical quality improvement
studies to assist in reducing unwarranted variation in clinical
practice in order to improve the quality and cost of care.
Interfaces with physicians and other providers in order to
facilitate implementation of recommendations to providers that
would improve utilization and health care quality. Reviews claims
involving complex, controversial, or unusual or new services in
order to determine medical necessity and appropriate
payment.Develops alliances with the provider community through the
development and implementation of the medical management programs.
As needed, may represent the business unit before various publics
both locally and nationally on medical philosophy, policies, and
related issues. Represents the business unit at appropriate state
committees and other ad hoc committees.Participating and chairing
committees, meeting with provider groups, help developing
policies.
Education/Experience:
Medical Doctor or Doctor of Osteopathy, board certified preferable
in a primary care specialty (Internal Medicine, Family Practice,
Pediatrics or Emergency Medicine). The candidate must be an
actively practicing physician. Need 3-5 or more years in practice
experience, prefer 2-4 years in FT/PT medical director or associate
medical director positions.Previous experience within a managed
care organization is preferred. Course work in the areas of Health
Administration, Health Financing, Insurance, and/or Personnel
Management is preferred. Experience treating or managing care for a
culturally diverse population preferred.
License/Certifications: Board Certification through American Board
Medical Specialties. Current state medical license without
restrictions.
Salary: $215,400 - $344,700
Community: Houston, Texas.
Keywords: Murdock Consulting, Houston , Physician / Emergency Medicine / Texas / Permanent / Internal Medicine, Healthcare , Houston, Texas
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