Medical Director

• Create and oversee clinical strategy for the region
• Provide medical leadership and strategy for Health Services Operations with fiscal responsibility for trend management
• Oversee regional utilization management and case management for inpatient cases, LTSS services and the Humana Medicare Model of Care
• Chair the Quality Management Committee and participate in Quality Operations
• Complete initial peer review on quality-of-care complaints
• Complete peer-to-peer written and verbal communications
• Oversee the administrative budget for regional Health Services Operations and Quality Improvement
• Approve or deny expense reports and requisition requests for department members
• Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs
• Participate in regional committees and meetings that set medical necessity strategies
• Oversee and direct implementation of regional clinical programs and strategies
• Develop and implement market-level strategies
• Manage internal operational and functional relationships related to profitability
• Assist with network development and provider contracting
• Serve as clinical liaison with inpatient facilities and joint operating committees
• Maintain facility relationships and resolve problems, including reviewing contracts regarding clinical services
• Apply knowledge of financial aspects of risk-bearing contracts to gain provider traction and adoption
• Work effectively in a highly matrixed environment

Medical Director jobs in Michigan

Chief Medical Officer – CMO