CNSI Hiring for Medical Director Full Time

JOB DUTIES

• Evaluate, redirect and/or respond to inquiries from physicians, providers and customer. Consult with general and/or specialty practitioners regularly and as necessary as business needs require.
• Represent and promote KEPRO at seminars, professional societies, medical staff meetings, and other professional settings as appropriate.
• Foster appropriate external relationships with attending physicians/surgeons by response to telephone calls and letters, speaking engagements before physician and provider organizations.
• Analyze and remain current on national, state, and local regulations and legislation, which impacts the health care profession.
• Review medical information trends, experiences and approaches, and assists in the development of strategic plans for clinical improvements.
• Ensures compliance with regulatory and accreditation requirements.
• Responsible for oversight of medical content of company publications.
• Participate in activities specific to contractual arrangements, i.e., Fair Hearings.
• Provide medical expertise with respect to planning and establishing goals and policies to improve medical management.
• Provides oversight of physician consultants and advisors. Conducts peer-to-peer physician consultations as requested/required, documents consultations.
• Work with medical, nursing and administrative staff to identify matters needing shared attention.
• Discuss, inform, and facilitate communication and interaction between staff with customers.
• Create and complete initial and annual UM program evaluation that includes UM program recommendations.
• Provide and review for medical necessity for services such as: Advanced Imaging, Audiology, Chiropractic, Dental, DME, Home Health, Hospice, Inpatient, Mental Health (including Psychiatry), MRO, Occupational Therapy, Optometry, Outpatient, Pharmacy, Physical Therapy, Physician, Podiatry, Rehabilitation, Speech Therapy, Transplant, and Transportation.

Required Qualifications

• M.D. or D.O. with current non-restricted license to practice medicine by the Board of Medical Examiners in the state of Indiana.
• License must be in same state as contractually required.
• Board certification in a clinical specialty is required.
• 10+ years of clinical practice preferred.
• 5 to 7 years of experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs, and coaching medical staff on healthcare business and practice issues.
• Minimum 2 years as a Medical Director in a managed care company preferred.
• Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare programs.
• Prior review experience or quality assurance committee responsibility in a hospital setting preferred.

Job Type: Full-time

Pay: $134,669.04 – $250,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Health savings account
• Paid time off
• Professional development assistance
• Referral program
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift

Ability to commute/relocate:

• Indianapolis, IN: Reliably commute or planning to relocate before starting work (Required)

Education:

• Doctorate (Required)

Experience:

• GCP: 10 years (Required)
• physician executive: 10 years (Required)

License/Certification:

• BC/BE (Required)
• Medical License (Required)

Willingness to travel:

• 25% (Preferred)

Work Location: One location