State: MN Contract Number: 42688 Client Reference: 42688 Job Title: Medical Director - CA Job Summary: Work in Irvine, California Medical Director One of the Nation's Largest Healthcare Organizations 100% Administrative The Medical Director interacts with physicians and IPA staff to ensure that patient needs are met in an efficient and medically appropriate manner. The Medical Director is responsible for the Medical Management functions that include vendor relations, Utilization Management, and business development. In addition, this role provides prime management, oversight, and development for major program and functional areas within Medical Management. These include medical policy, patient-centered medical home, Medicaid, health and wellness, population management, and reporting capabilities. The Medical Director is also responsible for working with physicians and other providers, especially PCMH practices, to improve the quality and efficiency of care in the network, and integrate these providers into clinical initiatives. Primary Responsibilities: Works primarily with the physician community around issues of particular patients, balancing business, and clinical concerns Provides limited utilization management for outpatient medical, surgical, and pharmacy activity Participates in medical appeals activity. Reviews all 2nd-level overturned cases related to medical necessity / investigational issues in the context of potential medical policy updates. Works with the appeals area on appeals related to utilization management issues Provides medical leadership and physician advice to the quality management area with respect to quality improvement studies, quality improvement committees, and primary care assessments (both office-site assessments and medical record document reviews) Performs peer reviews on quality complaints, sentinel events, and quality-of-care referrals Serves as Physician Advisor for other areas within the company, including but not limited to Sales and Marketing, Underwriting, PHP, and Provider Services Provides medical leadership and advice for conformance with standards and guidelines for NCQA, URAC, state and federal regulators, and other accrediting bodies Acts as liaison for communication with physicians, hospitals, and other providers in the community Reviews customer service and claims inquiries Qualifications Possess a current and unrestricted MD or DO license in California 5+ years of clinical practice in direct patient care 5+ years of medical management or administrative experience in a managed care setting Possess sufficient clinical knowledge to interact with the physician members of the IPA in all major medical specialties A proven track record of quality leadership and exceptional teamwork in order to build and foster stellar working relationships in both clinical and operational departments Excellent written and oral communication skills Board certification in their chosen specialty Preferred Qualifications: Board Certified in Geriatrics Prior experience working with clinical information technology systems Public presentation skills What's the first thing that happens when one of the most successful groups in Riverside County comes together with a global leader in healthcare? Opportunity. Within our organization people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work. About the Company: Merritt Hawkins Associates, an AMN Healthcare company, is a permanent physician placement service that fills more physician jobs than any other firm. In addition to being the nation's leader in physician employment search and consulting services, Merritt Hawkins also recruits and places select allied health professionals. AMN Healthcare is an EEO/AA/Disability/Protected Veteran Employer. We encourage minority and female applicants to apply.