Minneapolis, MN
The Corporate-level Associate Medical Director, along with the Chief Medical Officer and other Medical Directors, will oversee support of health care outcomes and administration of medical services. They will provide medical leadership and direction for the development, implementation and maintenance of excellent quality improvement, utilization management, and case management activities for members. The AMD will work collaboratively with other plan functions such as Health Care Economics, Provider Relations and Contracting, Health Promotion, Claims, and Compliance and provide support for other activities which require physician involvement.
Responsibilities
• Collaborate with Medical Director to provide support for the operation of the Clinical Services, Quality Management, Complaints/Appeals/Grievances, Credentialing, and Pharmacy Departments
• Serve as a medical manager and policy advisor to the health plan, Chief Medical Officer, and Medical Director
• Conduct reviews and case-level assessment of member care for case management, utilization management, quality improvement, complaint-appeal-grievance, and other member-level activities
• Assist with strategic planning for medical initiatives, cost initiatives, and provider relations
• Analyze data, clinical research, and published literature related to medical care in support of strategic objectives
• Support Medical Director, as needed, with the design and implementation of health plan medical policies, goals, and objectives
• Consult with community providers and experts regarding issues of quality and appropriateness of care
• Serve on appropriate internal and external committees particularly those affecting health care management or quality of care
• Conduct review of clinical care of high-risk members in targeted membership groups
• Assist the Claims Department by providing process support and medical reviews when necessary.
• Provide physician-to-physician contact regarding quality, credentials review, and utilization issues
• Participate in the analysis and evaluation of programs, policies, and procedures to determine their effects on quality of care and operational efficiency
• Represent when physician involvement on clinical issues is appropriate
• Promote positive community relations including meetings with community groups, the academic community, and medical organizations
• Attend meetings with regulators as appropriate and in coordination with Government Relations staff
• Participate in the achievement and maintenance of benchmarked, clinical quality objectives, utilization, and cost management goals
Qualifications
• Three to five years experience in managed care environment is strongly preferred
• Experience should include quality improvement, utilization review, case management, risk management, and patient care
• Knowledge and advocacy of managed care principles and the primary care model required
• Experience with practice guidelines and outcome data analysis preferred
Minimum of 5 years medical practice experience
• Current unrestricted medical license in Minnesota as a Doctor of Medicine (MD) is required and verified throughout employment (Note that initial temporary exemption from this requirement with a firm ending date can be negotiated at time of hiring.)
• Board Certification in a specialty recognized by the American Board of Medical Specialties (ABMS)
Knowledge, skills, and abilities required to be successful in this role
• Excellent interpersonal, oral, and written communication skills
• Excellent organizational, analytical, and problem solving skills
• Ability to work collaboratively with other staff in a team setting
• Ability to coordinate time-sensitive, member-related activities such as reviews with broader operational and strategic projects
• Ability to translate clinical issues into managed care concepts and to represent these concepts to the broader community
