Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm
Company: Necnic Group, LLC
Posted on: April 17, 2019
Medical Doctors Only Apply. A Family Practice Physician Traditional
Practitioner practice is seeking a qualified physician for
Columbia, SC. This and other physician jobs brought to you by
Chief Medical Director
Purpose: Direct and coordinate the medical management, quality
credentialing functions for the assigned business unit based on,
and in support
of the strategic plan, establishing the strategic vision and
Serves as clinical advisor to and educator of medical
management staff making sure correct clinical judgment is applied
medical management determinations.
Oversees internal medical review guidelines to ensure
clinical integrity and compliance and acts as a resource for staff
throughout the operation.
Coordinates with other departments, the responses needed to
regulatory accreditation concerns pertaining to medical management
Performs medical review activities pertaining to utilization
review, quality assurance, and medical review of complex,
or experimental medical services.
Facilitates the achievement of the Medical Management Program
goals through an effective health services delivery system.
Responsible for physician review and oversight of all
potential adverse determinations including
authorizations, concurrent review and appeals/retrospective
Responsible for HEDIS improvement and strategy.
Actively participates in the auditing process of medical
management processes and corrective action team projects for
Achieves utilization, cost management and quality goals.
Participates and advises in the development of corporate
medical policies for UM, pharmacy, and new technology
For Home State Health Plan only --- responsible for the sufficiency
supervision of the health plan provider network
Directly involved in the CHC-MCO's recruiting and credentialing
Familiar with local standards of medical practice and
nationally accepted standards of practice, including those for LTSS
with most integrated setting requirements under the ADA.
Knowledge of due process procedures for resolving issues
between Network Providers and the CHC-MCO administration, and
participants and the CHC-MCO, including those related to medical
making and utilization review.
Available to review, advise and take action on questionable
hospital admissions, Medically Necessary days and all other medical
and medical cost issues.
Directly involved in the CHC-MCO's process for prior
authorizing or denying services and is available to interact
Providers on denied authorizations.
Knowledge of current peer review standards and techniques.
Knowledge of risk management standards.
Directly accountable for all Quality Management and
Utilization Management activities.
Oversees and is accountable for: (a) referrals to the
Department and appropriate agencies for cases involving quality of
and services that have adverse effects or outcomes; and (b) the
for potential Fraud, Waste, and Abuse audit, investigation,
sanctioning and referral to the appropriate oversight agencies.
Medical Doctor or Doctor of Osteopathy, board certified in a
recognized by the American Board of Medical Specialists. Volunteer
required. Previous experience as Medical Director is preferred.
in Business Administration, Public Health, Healthcare
Administration or related
License/Certificates: Board Certification through American Board of
Specialists. Current state medical license without
20% CLINICAL PRACTICE 20% Program, Clinical Internal (CM, 20% UM
Administrative (provider relations etc)
Willing to work
in the office 4 days a week and 1 day of clinical practice
Keywords: Necnic Group, LLC, Columbia , Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm, Healthcare , Columbia, South Carolina
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