Description:
GENERAL SUMMARY
- Provides direction and oversight to Medical Directors in a large health plan.
- Provides technical expertise in medical management by direct decision making in the areas of preauthorization, concurrent review of hospitalized patients, discharge planning, and complex case management.
- Oversees the quality improvement and pharmacy programs for the health plan.
- Chairs (or staffs) all peer-review committees such as Quality Improvement, Pharmacy and Therapeutics, Credentialing and others that are deemed appropriate for the health plan.
- Analyzes medical cost drivers and develops specific plans to reduce excessive cost.
- Works with the health plan CEO to develop strategic approaches to improve company performance and expand growth by optimizing the provider network, evaluating provider (hospital, physician, ancillary) contracts, and developing other creative approaches.
- Provides guidance and is responsible for all clinical aspects of the program.
- Has periodic consultation with practitioners in the field as necessary.
- Ensures a staff of qualified clinicians accountable to the organization for decisions affecting consumers is maintained, and that appeals are reviewed by non-subordinate board certified specialists.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Louisville, KY, US
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-02-27 00:00:00.0
Job ID: 1310721
GENERAL SUMMARY
Provides medical leadership and oversight to Medical Directors in a health plan in order to provide excellent quality of care and service to our members that is cost efficient.
ESSENTIAL RESPONSIBILITIES
- Provides direction and oversight to Medical Directors in a large health plan.
- Provides technical expertise in medical management by direct decision making in the areas of preauthorization, concurrent review of hospitalized patients, discharge planning, and complex case management.
- Oversees the quality improvement and pharmacy programs for the health plan.
- Chairs (or staffs) all peer-review committees such as Quality Improvement, Pharmacy and Therapeutics, Credentialing and others that are deemed appropriate for the health plan.
- Analyzes medical cost drivers and develops specific plans to reduce excessive cost.
- Works with the health plan CEO to develop strategic approaches to improve company performance and expand growth by optimizing the provider network, evaluating provider (hospital, physician, ancillary) contracts, and developing other creative approaches.
- Provides guidance and is responsible for all clinical aspects of the program.
- Has periodic consultation with practitioners in the field as necessary.
- Ensures a staff of qualified clinicians accountable to the organization for decisions affecting consumers is maintained, and that appeals are reviewed by non-subordinate board certified specialists.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Louisville, KY, US
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-02-27 00:00:00.0
Job ID: 1310721