Shire Jobs

JOB REQUIREMENTS: Senior Medical Director - Medical Management Job Locations US-WI-Madison ID 2024-2198 Category Clinical Services Type Regular Full-Time Overview Are you a physician leader with experience working in a managed care setting? Are you ready to revolutionize healthcare and make a lasting impact on the well-being of communities? We are seeking an experienced Senior Medical Doctor to lead our Medical Management. As the Senior Medical Director specializing in Medical Management, you will oversee a team of Associate Medical Directors and be responsible for second level medical necessity reviews, offering expert medical opinion and guidance on complex cases. Benefits: Unique, provider-sponsored model, enabling care and outcomes that are more integrated, less duplicative, and more lasting; with the added advantage of being aligned to some of the top hospitals and healthcare systems in the country. Latitude and encouragement to think differently and leave a legacy of innovation through leading the delivery of solutions and care models that will improve the lives of Quartz members and the overall healthcare delivery system. Competitive compensation and benefits package, with the flexibility to work remotely as needed Responsibilities Conduct medical necessity reviews and determinations of prior authorizations and referrals, including reviews of previously denied and appealed decisions Oversight and day-to-day management of a team of Associate Medical Directors, including performance management, timekeeping, and managing the MD calendar to ensure adequate coverage during business hours and ad hoc Provide clinical strategy and physician input to various Clinical Services departments, including: Utilization Management, Care Management, Medical Policy, Behavioral Health, Population Health, Quality, and Clinical Informatics Qualifications MD or DO with current and ongoing Board Certification in an ABMS Medical Specialty Unrestricted current medical license in the state of Wisconsin and other states as necessary. 12+ years of direct clinical patient care experience post residency or fellowship, with at least 3 years working in managed care setting. Knowledge of medical management principles, including utilization management, prior authorization, case management, concurrent and retrospective review - including experience working with national guidelines such as MCG and InterQual Familiarity with the National Committee for Quality Assurance (NCQA) Health Effectiveness Data and Information Set (HEDIS) principles, accrediting requirements, and CMS Star ratings for Medicare lines of business Ability to plan, organize, execute assignments to meet deadlines Ability to communicate in a manner that builds constructive, effective relationships with colleagues across... For full info follow application link. Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individual with Disabilities ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/636F7223098E4A6F