Senior Medical Director - Health Plan - Abrazo Health Care - Phoenix

Job description
The Senior Medical Director performs all the duties of a health plan medical director. In addition to this, by virtue of his or her experience in medical management and in managed care, the Senior Medical Director represents the Medical Division to the health plan, providers, and regulators, in the absence of the Chief Medical Officer.
Desired Skills and Experience
SPECIAL SKILLS: Understands health plan medical functions, such as prior authorization, concurrent review, and peer review. Able to use clinical
practice guidellines to make medical necessity determinations. Skillled at managing physician peer communications and support the health plan's
nurses , social workers, pharmacists, coordinators, and managers in their duties. Understands managed care, the regulatory environment for
Medicare and Medicaid, and is able to work through regulatory issues to solve or prevent issues. Able to lead teams of medical personnel to
improve utilization and quality outcomes, using continuuous qualtiy improvement. Understands how to use metrics and how to obtain and analyze
data to monitor and manage key aspects of medical management performance. Able to act as an advisor to the health plan and as a liaison to
other departments on medical affairs in the absence of the Chief Medical Officer.
SUPERVISES: No direct reports but leads teams in the medical department
MINIMUM EDUCATION: Medical or Osteopathic Doctor (M.D. or D.O.), with at least three (3) years of post-doctorate clinical training
PREFERRED EDUCATION: M.B.A. or similar graduate business degree
MINIMUM EXPERIENCE: Minimum of 7 years in clinical practice with board certification; Minimum off 10 years of managed care heatlh plan
medical management expereince with at least 2 years of Medicaid and 2 years of Medicare experience.
PREFERRED EXPERIENCE: At least 1 year of commercial health plan experience, prior health plan NCQA or URAC accreditation experience
REQUIRED CERTIFICATIONS/LICENSURE: Arizona license to practice medicine, board certification in an ABMS recognized specialty
REQUIRED COURSE(S) TRAINING: Maintain 40 Category I CME hours, every 2 years as required by Arizona for medical licensure

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