Medical Director – Managed Care Plans

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🔥 11 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Jefferson

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

At Jefferson, we’re more than 65,000 people strong, united in our mission to deliver the highest-quality compassionate care and education across the greater Philadelphia region, Lehigh Valley, Northeastern Pennsylvania, and southern New Jersey. With 32 hospital campuses, we are a nationally ranked leader not just advancing healthcare—we’re shaping healthier communities, pioneering groundbreaking research, and educating tomorrow’s leaders.

📋 Description

• Shape the future of healthcare delivery across one of the nation’s leading academic health systems. • Lead clinical strategy and utilization management for our integrated health plans and care management programs. • Perform utilization review for requests for services including but not limited to inpatient, outpatient, pharmacy and dental. • Conduct peer-to-peer discussions with providers. • Serve on and support the functions of committees including but not limited to the Utilization Management Committee and Pharmacy & Therapeutics Committee. • Advise the HealthCare Senior Management team regarding the utilization of health care services and interventions to promote the effective delivery of medically necessary services. • Participate and/or lead rounds including but not limited to disease management, care management or admissions. • Provide support for Plan accreditation processes (NCQA), Utilization, Quality and Disease Management programs. • Develop and or revise practice guidelines for acute and chronic care. • Develop and implement policies and procedures required to promote effective utilization management and achieve established targets. • Collaborate with HealthCare Economics and Finance to continuously improve the collection and use of data describing resource utilization and outcomes. • Represent HealthCare Management internally and externally at the direction of the VP Chief Medical Officer. • Develop and implement work plans to optimize appropriate utilization and quality targets as directed by the VP Chief Medical Officer. • Perform other job duties as assigned.

🎯 Requirements

• Medical Physician (MD or DO) required • Pennsylvania Medical License without restriction • Board Certification in a specialty (primary care preferred) • Graduate business degree is a plus (MBA, MMM, etc.) • Minimum 5 years post-residency experience in the clinical practice of medicine • Managed care experience, with responsibility for utilization management • Excellent organizational, interpersonal, time management and communications skills • Strong leadership skills. • Strong conflict resolution and independent decision-making skills • Expert project management ability • Strong influencing, negotiation and analytical skills • Working knowledge of PC based applications such as Excel, Access and Word • Knowledge of the principles of Utilization, Quality and Care Management.

🏖️ Benefits

• medical (including prescription) insurance • supplemental insurance • dental insurance • vision insurance • life and AD&D insurance • short- and long-term disability • flexible spending accounts • retirement plans • tuition assistance • access to group rates on insurance and discounts • tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service • access to medical (including prescription) insurance for all colleagues, including those who work less than part-time