FresnoRecruiter Since 2001
the smart solution for Fresno jobs

55-247 Physician / Pediatric: Medical Director / Fresno, CA sm 93702

Company: Executive Staff Recruiters
Location: Fresno
Posted on: July 13, 2019

Job Description:

Allied Specialty - State California Physican Speciality Pediatrics: Medical Director Sub Specialty Medical Director Position Type Permanent Recruiter 258 Internal ID JJJ23 Description Physician / Pediatric: Medical Director / Fresno, CA Assist the Chief Medical Director to direct & coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for capitated providers. Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities of physician advisors. Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. Develops alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees. Participating and chairing committees, meeting with provider groups, help developing policies. Education/Experience: Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine). The candidate must be an actively practicing physician. Need 3-5 or more years in practice experience, prefer 2-4 years in FT/PT medical director or associate medical director positions. Previous experience within a managed care organization is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred. Experience treating or managing care for a culturally diverse population preferred. License/Certifications: Board Certification through American Board Medical Specialties. Current state medical license without restrictions. Salary: $215,400 - $344,700 Community: Fresno, California.

Keywords: Executive Staff Recruiters, Fresno , 55-247 Physician / Pediatric: Medical Director / Fresno, CA sm 93702, Executive , Fresno, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Business Manager - RCCB
Description: Position Summary:As a key member of the management team, the Business Manager must ensure compliance with all company policies and procedures while using analytical skills to be a resource to the Distribution (more...)
Company: Reyes Coca-Cola Bottling
Location: Fresno
Posted on: 07/18/2019

Director for Employer Connections & Internships
Description: Director for Employer Connections Internships br br Job Category: br br Managerial/Professional br br Unit: br br Center for Career and Professional Advancement br br Position Code: (more...)
Company: University of California - Merced
Location: Merced
Posted on: 07/17/2019

Restaurant Manager
Description: Panda Express managers can have the opportunity to embody an entrepreneurial spirit while learning from a very hands-on and fast-paced environment. As a General Manager, you will be in charge of a 1-2 (more...)
Company: Panda Express
Location: Modesto
Posted on: 07/17/2019


Market Manager
Description: Is it your goal to run your own business and be a strong presence in your community and beyond Do you thrive in an environment that empowers you to make decisions and create a winning culture br As (more...)
Company: ManpowerGroup
Location: Fresno
Posted on: 07/18/2019

Assistant Director
Description: How would you like to be part of a consulting firm that changes how customers view consultants--Would you like to lead a Team that creates extraordinary customer value at the same time as driving bottom (more...)
Company: Forensic Analytical Consulting Services Inc.
Location: Fresno
Posted on: 07/17/2019

Associate Executive Director
Description: General Description The Fresno Teachers Association FTA is a single unit Option 2 UniServ.--One Executive Director, two support staff, two Associate Executive Directors, and a full-time president work (more...)
Company: Fresno Teachers Association
Location: Fresno
Posted on: 07/17/2019

General Manager
Description: DescriptionTo eat. To laugh. To share. That's why people come to Pizza Hut. It's the calling of our Restaurant General Managers to make them feel like family with smiles, teamwork and dedication. If you're (more...)
Company: Pizza Hut
Location: Merced
Posted on: 07/18/2019

Asst. Manager, Home Services CA - Fresno / Santa Maria
Description: Asst. Manager, Home Services 3PL - CA - Fresno / Santa Maria Job Category Services/Installation/Repair Location Number Best Buy Market 8 Offices Job Description The Asst. Manager, Home Services 3PL is (more...)
Company: Best Buy Co
Location: Fresno
Posted on: 07/18/2019

Nurse Manager - Surgery
Description: Full-time Manager of Surgery needed Reference Code: KAM Job Description: This position is accountable for the overall direction, coordination and evaluation
Company: KA Recruiting, Inc.
Location: Madera
Posted on: 07/17/2019

Forward Planning Manager
Description: The Land Development Forward Planning Manager by its nature is broad in scope and subject to modification from time to time. The following description is not meant to be restrictive, but to generally (more...)
Company: Wathen Castanos Homes
Location: Clovis
Posted on: 07/17/2019

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Fresno RSS job feeds