Medical Director

Job Title: Medical Director Location: Brentwood, TN, 37027 Duration: 3 months with contract extensionsShift: Business hoursDescription:Reporting to the CMO, the LTSS Medical Director will serve the Tennessee LTSS population.Responsibilities for a Medical Director include:-Performs daily review of home and community-based services to approve or deny appropriate services for members. Will work with nursing staff to clarify requests and documentation as needed-Represents the health plan in Board of Hearing cases-Responsible for appropriate utilization management including managing/monitoring the results of Care Management/ Health services interventions to ensure that utilization goals are achieved, collaborating with Care Management/ health services/behavioral health as necessary to maintain focus on achieving targets.-Works toward fully integrated clinical model working with Behavioral Health and clinical management-Supports all clinical quality initiatives and peer review processes-Collaborates with the health plan Chief Medical Officer, and other clinical staff as a clinical resource and coach to support programs and health plan goals- Collaborates with the Chief Medical Officer, clinical operations staff, and other market staff to support and meet market and national clinical operations goals.-Accountable for providing clinical leadership primarily focusing on home and community-based services review and external communication with network physicians-May assist in the development and implementation of local plan clinical policies and procedures, quality improvement activities and performance improvement projectsQualifications:- Active/unrestricted Licensed physician- Board Certified in an ABMS or AOBMS specialty- 5+ years clinical practice experience; strong knowledge of managed care industry and the Medicaid line of business, specifically long-term services and supports.- 2 – 3 years Quality management experience- Familiarity with current medical issues and practices- Strong leadership skills as demonstrated by continuously improved results/team building, and effectiveness in a highly matrixed organization- Excellent interpersonal communication skills- Superior presentation skills for both clinical and non-clinical audiences- Proven ability to develop relationships with network/community physicians and other providers- Excellent project management skills- Solid data analysis and interpretation skills; ability to focus on key metrics- Strong team player and team building skills- Strategic thinking with proven ability to communicate a vision and drive results- Solid negotiation and conflict management skills- Creative problem-solving skills.- Proficiency with Microsoft Office applications