Regional Medical Director

Responsibilities The Regional Medical Director is responsible for providing clinical expertise and business direction in support of medical management programs which promote the delivery of high quality medical care. Provides technical expertise in medical management by direct involvement in inpatient and out-patient authorization, appeals and grievances. Takes an active role in designing and implementing quality improvement programs for the region and representing the region in corporate committees. This position is responsible for all UM activities including, but not limited to adherence to clinical guidelines, measuring adherence to guidelines, and communicating utilization and quality concerns on specific cases to the provider network.  Qualifications Graduation from an accredited medical school with a degree of M.D. or D.O. Completion of approved residency. Board Certification is preferred. Current unrestricted license to practice medicine within the State of California. Five years' experience practicing medicine in a managed care environment. Two years' experience in medical management, preferably with an IPA.    Valid California driver's license required. Knowledge of current laws and regulations governing HMOs, capitation, and risk-based physician and hospital payment methodologies.                                                        Knowledge of Medi-Cal and Medicare programs. Ability to identify healthcare needs of enrolled populations. Working knowledge of NCQA and HEDIS measurement, indicators and methodologies preferred. Experience in the use of measures of clinical effectiveness and outcomes, and their use in performance improvement. Strong clinical skills and knowledge of concurrent review, case management, ambulatory utilization review. Understanding of physician practice management and medical information systems is required. Demonstrates a high degree of judgment, resourcefulness, diplomacy and organizational abilities. Must be attentive to detail, accurate, thorough, and persistent in following through to completion of all activities. Excellent communication skills; able to read, write, and speak articulately. Able to use established channels of communication and reporting relationships within the organization 2018-55942
Salary Range: NA
Minimum Qualification
5 - 7 years

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