Medical Director, Quality Improvement

A large healthcare organization needs a qualified MD or DO to join as the Medical Director- Quality Improvement.  This position will allow you to support the new initiative of Aged, Blind and Disabled in a highly visible leadership role. 

Healthcare Organization

The Medical Director is accountable for the establishment and implementation of quality improvement and utilization standards.  Responsibilities include:

• Providing overall medical expertise to ensure continuous quality improvement; cost-effective service to subscribers, maintenance of effective provider relations, and development and implementation of Utilization Management and Complex Case Management programs
• Accountability for developing clinical innovations and assures the implementation of enterprise policies and procedures, and the achievement of business plan goals in areas of accountability
• Involvement in the Continuous Quality Improvement Committee, Quality Peer Review Committee
• Developing and implementing provider education programs related to clinical quality improvement activities and Complex Case Management activities for all population
• Developing programs to improve the performance of providers related to clinical performance reports

• Board certified MD or DO
• Managed care & managerial experience board certification
• NCQA/QM
• Knowledge of Utilization Management, Continuous Quality Improvement, Complex Case Management programs and principles of prevention and wellness
• Knowledge of NCQA Standards and experience in successful plan accreditation
• Familiarity with ICD-9 and CPT Coding