Medical Director (29757)

SUMMARY 
The Medical Director is responsible for providing guidance and oversight pertaining tthe clinical quality aspects of the program and ensure compliance with policies, federal and state legislative mandates, and applicable regulatory agency standards 

ESSENTIAL JOB FUNCTIONS

•    Serve as standing active member of the quality management committee (QMC) 
•    Provide general guidance and input regarding the overall organization and effectiveness of the quality oversight program.
•    Review service measures and, when applicable, participate in the development of corrective action plans.
•    Review quality audit results and, when applicable, participate in the development of corrective action plans.
•    Review information related to complaints and, when applicable, participate in the development of corrective action plans.
•    Serve as a standing active member of the credentialing committee.
•    Review, provide input, and approve all policies and procedures related the clinical aspects of the program. 
•    Provide general guidance and input regarding the overall content, delivery and effectiveness of the independent medical evaluator training program. 
•    In concert with the Sr. Vice President of Compliance and Network Development, deliver periodic communication to reviewers regarding clinical, quality and administrative aspects of IME performance. 
•    Provide guidance for clinical operational aspects of the program, when applicable.  
•    Responsible for oversight of clinical decision-making aspects of the program, when applicable. 
•    Provide periodic consultation with practitioners in the field. 

Education and/or Experience  
MD, DO, or DPM degree required.  Industry related experience preferred. Experience in the design and/or implementation and oversight of a quality management program preferred. Knowledge of federal and/or state legislative mandates (ERISA and/or state law) preferred. Working familiarity with regulatory agency standards (URAC, NCQA) preferred. Postgraduate experience in direct patient care.

Certificates, Licenses, Registrations  
Board Certification in ABMS and or AOA- recognized specialty required if an MD or DO. Current unrestricted license to practice medicine required.

 

QUALIFICATIONS  
•    Ability to provide clinical guidance regarding the quality and/or clinical aspects and, when appropriate, directly communicates with individual independent medical evaluators, staff, and/or clients; travel as required.
•    Ability to interact with clients as needed, either independently or as a participating member of a group discussion between service and client, regarding the clinical quality aspects of an independent medical evaluation and/or the quality program.
•    Ability to ensure the organizational objective to have qualified clinicians accountable to the organization for decisions affecting consumers, when applicable. 
•    Must have knowledge of federal and/or state legislative mandates (ERISA and/or state law).
•    Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

ABOUT US

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.