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Sr Medical Director - Remote buy in US, Free Classifieds Ads

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare?now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.
We are seeking a talented individual for a Sr.Medical Director who works under the direction of the Chief Medical Officer (CMO), the Senior Medical Director (SMD) provides clinical leadership for the HMS Physician Team and HMS Clinical Staff. The SMD will provide physicaian oversight of HMS clinical activities, client provider facing activities and development/maintenance of the HMS Contracted Physician Network. The SMD will have primary responsibility for physician oversight of program documentation and execution. The SMD will assist the CMO in thought leadership, product ideation, client facing sales/account management support.
Essential Responsibilities:
+ Lead HMS Physician team in efficient and effective performance of daily activities including clinical reviews, quality reviews, appeals reviews, client and provider facing interactions around clinical review issues
+ Direct supervision of HMS Medical Director activities and performance
+ Lead physician efforts in new audit/edit ideation, development and supporting documentation for HMS Clinical Programs (policies, SOPs, clinical guidelines, job aides)
+ Lead physician oversight of clinical review audit programs processes and outcomes in conjunction with Clinical Services leadership (finding rates, quality rates and appeals overturn rates
+ Participate with CMO as directed in client meetings to support Sales/Account Management clinical relationship building or program support
+ Oversight of development, training, maintenance and financial performance of HMS Contracted Physician Network
+ Participate with CMO as directed in thought leadership activities (i.e. blog posts, conference speaking, white papers, etc.)
Non-Essential Responsibilities:
+ Performs other functions as assigned
Knowledge, Skills and Abilities:
+ High level of English language communication skills (verbal and written)
+ Understanding of health plan operations, payment integrity audits and basic medical claims payment
+ Basic computer skills- Word, Excel, Outlook, remote connections
+ Familiarity with basic medical management criteria sets- Interqual, MCG
+ Familiarity with researching federal and state regulatory guidance around medical services coverage and claims payment (NCD, LCD, state regulations, CMS Manuals, CFR)
Work Conditions and Physical Demands:
+ Primarily sedentary work in a general office environment
+ Ability to communicate and exchange information
+ Ability to comprehend and interpret documents and data
+ Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
+ Requires manual dexterity to use computer, telephone and peripherals
+ May be required to work extended hours for special business needs
+ May be required to travel at least 30% of time based on business needs
Minimum Education:
+ Doctor of Medicine Degree (M.D. or D.O.) from an accredited US (or comparable country) Medical School
+ Completion of a recognized and accredited US (or comparable country) Residency Training Program
Certifications (Required/Desired):
+ Active, unrestricted license to practice medicine in at least one U.S. state is required
+ Active Board Certification by an American Board of Medical Specialty (ABMS) recognized specialty board is required
+ No history of Medicare or Medicaid sanctions (required)
Minimum Related Work Experience
+ Requires at least 5 years of experience working as a medical director, senior medical director or chief medical officer at a health plan or managed care organization or 5 years of experience as a medical director, senior medical director or chief medical officers of a payment integrity organization (health plan experience preferred)
+ Desired experience includes leading teams of other physicians and clinical staff
+ Desired experience includes direct involvement in and leadership of medical management, quality improvement, care management, medical coding, risk score, medical claims payment, pharmacy management, claims audit or payment integrity activities
_Nothing in this job description restricts management?s right to assign or reassign duties and responsibilities to this job at any time._
Title: _Sr Medical Director - Remote_
Location: _Texas-TX-Remote_
Requisition ID: _180010YL_
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