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MEDICAL DIRECTOR PRESBYTERIAN HEALTH PLAN

Company: Presbyterian Healthcare Services
Location: Albuquerque
Posted on: August 17, 2019

Job Description:

SunIRef:it MEDICAL DIRECTOR PRESBYTERIAN HEALTH PLAN Presbyterian Healthcare Services 233 reviews - Albuquerque, NM 87106 Presbyterian Healthcare Services 233 reviews Read what people are saying about working here. Assures mission, goals, and strategy of PHP/PHS are met via strategic planning, operational management, and financial accountability in areas of responsibility. Promote and model the use of Continuous Quality Improvement techniques and measurements in reaching the PHS purpose to improve the health of individuals, families, and communities in the areas we serve Responsibilities Responsibilities: Primary responsibility for and direction of PHP utilization management activities, including direction and support for nurses in prior authorization, concurrent and retrospective review, referral coordination, and case management activities. Assists in identifying and addressing examples of inordinate variation in patterns of utilization, and guiding staff and providers to effective resolution. Assists in the development of strategic plans for addressing resource management concerns and opportunities. Provides leadership in the education of members, providers, and PHS entities in the principles of utilization/resource/cost management, particularly as this relates to PHP. Participates in ongoing identification, design, and development of clinical practice guidelines/disease management pathways, incorporating both national standards and local physician input. Maintains effective liaison with provider groups in order to foster open communication and engender a collegial atmosphere in working toward a common goal: quality, cost effective health care. Supports Delegated Groups and the PHP goal of PDT success through collegial educational efforts and facilitation of communication with these groups. Participates in development and implementation of an outcomes-oriented PHP Quality Management Program. Monitors and assists in the implementation of a quality, cost effective pharmacy program. Participates in all appropriate committee activities within the Quality committee structure. Participates in relevant strategic and benefit planning sessions. Insures compliance with HCFA, HSD, DOI and all other regulatory agencies. Supports PHP in achieving and maintaining NCQA, HCFA, IPRO and all other accrediting requirements. Helps to ensure the implementation of an effective information system which is relevant in measuring both quality and utilization outcomes. Supports efforts of PHP in developing and distributing a severity-adjusted Physician Practice Profile. Supports PHS-wide Health management activities designed to improve the health of those individuals, families, and communities we serve. Performs other functions as required. Qualifications Education: Essential: Medical Degree Benefits Benefits Benefits are effective day-one (for .45 FTE and above) and include: Competitive salaries Full medical, dental and vision insurance Flexible spending accounts (FSAs) Free wellness programs Paid time off (PTO) Retirement plans, including matching employer contributions Continuing education and career development opportunities Life insurance and short/long term disability programs Presbyterian Healthcare Services - Just posted - report job - original job Overall, how relevant is this job? Not at all 1 2 Somewhat 3 4 Extremely 5 On Company Site

Keywords: Presbyterian Healthcare Services, Albuquerque , MEDICAL DIRECTOR PRESBYTERIAN HEALTH PLAN, Executive , Albuquerque, New Mexico

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