REMOTE - Medical Director for Managed Care Plans at Jefferson Health Plans

Job Details

Shape the future of healthcare delivery across one of the nation’s leading academic health systems. Jefferson Health is seeking a visionary Enterprise Medical Director to lead clinical strategy and utilization management for our integrated health plans and care management programs.

This is a Full-Time Remote role.

Job Description

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Perform utilization review for requests for services including but not limited to inpatient, outpatient, pharmacy and dental. This will include 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.

• Support ongoing activities in OB, pediatric, adolescent, adult preventative, and geriatric care.

• 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.

• Required Education and Experience:

• 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.

• Skills/Abilities:

• 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.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research.