Medical Director

Description

JOB PURPOSE:

To provide operational expertise and medical decision support and direction for the day-to-day activities in the areas of medical management and medical affairs for SCAN.
To ensure the provision of high quality health care to SCAN members by planning, implementing, controlling, and evaluating health care delivery programs and operations.
To identify the standards for health care quality and service excellence.

ESSENTIAL JOB RESULTS:

Maintains company operations by initiating coordinating, and enforcing operational, personnel, and corporate medical policies and procedures.

Acts as liaison with provider groups for all medical practice matters. Ensures provider network meets SCAN strategic goals

Provides medical guidance and interpretation for all utilization management issues (prior authorization, concurrent review, and retrospective review and claims payments) and for all quality management department issues.

Chairs Peer Review, Credentialing, and Pharmacy & Therapeutics committees or others as directed.

Acts as liaison to corporate medical department - identifying short-term and long-range issues to be addressed; providing information and medical recommendations pertinent to deliberations; presenting options and recommending courses of action, especially where medical and legal considerations are involved.

Maintains the stability and reputation of the company by complying with all appropriate regulatory requirements.

Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.

Maintains client confidence and protects operations by keeping information confidential.

Provides support and technical knowledge for any SCAN physician education activities.

Requirements

PREFERRED QUALIFICATIONS:

Licensed physician able to practice medicine in the state of California (required).
Demonstrated competency as a practicing physician.
Experience in utilization and quality management (preferably at the HMO level).
Medical Management or advanced business degree.
Strong interpersonal skills, excellent written and oral communication skills; commitment to detail.
Demonstrated leadership and management skills.