{"id":2197,"date":"2018-04-13T19:53:28","date_gmt":"2018-04-13T19:53:28","guid":{"rendered":"http:\/\/nexushc.com\/?p=2197"},"modified":"2018-04-13T20:06:37","modified_gmt":"2018-04-13T20:06:37","slug":"medical-director-dc","status":"publish","type":"post","link":"http:\/\/nexushc.com\/?p=2197","title":{"rendered":"Medical Director (DC)"},"content":{"rendered":"<p><span class=\"highlight1\">Washington DC<\/span><\/p>\n<p>The Medical Director will\u00a0provide medical leadership for utilization management, cost containment, and medical quality improvement activities.<!--more-->The candidate will perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.<\/p>\n<ul>\n<li>Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.<\/li>\n<li>Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.<\/li>\n<li>Participates in provider network development and new market expansion as appropriate.<\/li>\n<li>Assists in the development and implementation of physician education with respect to clinical issues and policies.<\/li>\n<li>Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit\/payment components.<\/li>\n<li>Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.<\/li>\n<\/ul>\n<p><strong>Requirements<\/strong><\/p>\n<ul>\n<li>MD<\/li>\n<li>Must be licensed to practice in the state.<\/li>\n<li>Must be Board-certified in his\/her medical specialty.<\/li>\n<li>Must be clear of any sanctions by the applicable state or Office of the Inspector General.<\/li>\n<li>Must not be prohibited from participating in any Federally or State funded healthcare programs.<\/li>\n<li>Full-time experience as an administrator in a Medicare or state-level Medicaid program, <span class=\"il\">Health<\/span> Maintenance Organization (HMO), Preferred Provider Organization (PPO), large <span class=\"il\">Health<\/span> Care Organization, <span class=\"il\">health<\/span> plan or any combination thereof.<\/li>\n<li>8+ years\u2019 experience in senior management and or Medical Director experience; 7 years Utilization Review and Case management experience<b>.<\/b><\/li>\n<li>5+ years of medical management and general management experience in a managed care environment is preferred.<\/li>\n<li>Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer in a Managed Care Plan preferred.<\/li>\n<li>Utilization management experience preferred. Minimum five years of progressive business experience.<\/li>\n<\/ul>\n<p><a class=\"button large button default fusion-button button-3d button-round button-large button-default button-28 buttonshadow-no\" title=\"Apply Now\" href=\"mailto:nexusexecutivesearch@gmail.com?subject=I am interested in the MD DC Position\" target=\"_blank\" rel=\"noopener\" type=\"button\"><span class=\"fusion-button-text\">Apply Now<\/span><\/a><\/p>\n<p><span style=\"color: #336699; font-size: 13px;\">Not sure if you want to apply?<br \/>\nContact us for more info:<br \/>\nRebecka Boyd<br \/>\n804-502-0870<br \/>\n<a href=\"mailto:nexusexecutivesearch@gmail.com\"> nexusexecutivesearch@gmail.com<\/a><\/span><\/p>\n<p><script src=\"\/\/platform.linkedin.com\/in.js\">\/\/ <![CDATA[ lang: en_US \/\/ ]]><\/script><br \/>\n<script type=\"IN\/FollowCompany\" data-id=\"360463\" data-counter=\"none\"><\/script><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Washington DC The Medical Director will\u00a0provide medical leadership for utilization management, cost containment, and medical quality improvement activities.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[5],"tags":[],"class_list":["post-2197","post","type-post","status-publish","format-standard","hentry","category-physician-executives"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p81ptW-zr","_links":{"self":[{"href":"http:\/\/nexushc.com\/index.php?rest_route=\/wp\/v2\/posts\/2197","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/nexushc.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/nexushc.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/nexushc.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/nexushc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2197"}],"version-history":[{"count":6,"href":"http:\/\/nexushc.com\/index.php?rest_route=\/wp\/v2\/posts\/2197\/revisions"}],"predecessor-version":[{"id":2215,"href":"http:\/\/nexushc.com\/index.php?rest_route=\/wp\/v2\/posts\/2197\/revisions\/2215"}],"wp:attachment":[{"href":"http:\/\/nexushc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2197"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/nexushc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2197"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/nexushc.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2197"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}