• Medical Director

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5118
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Medical Director is responsible for assisting with the medical management activities including Utilization Management, Quality Improvement, Credentialing, Maternal/Child health care, Pharmacy, and Behavioral Health to improve the health care delivery system for effective delivery of medical care.  The Medical Director is also a member of the Virginia Premier Health Plan, Inc. Health Quality Utilization Management (HQUM) Committee.

    Responsibilities

    • Assisting the CMO and Medical Directors in the following activities:
      • Medical Utilization Management
      • Medical Quality Assessment and Improvement activities
      • Outreach programs
      • Development of practice and preventive guidelines
      • Ensuring regulatory and accreditation compliance
      • Serving as a Virginia Premier representative in designated local meetings with managers, provider offices, local and state health care organizations
      • Reviewing Part D pharmacy initial and subsequent requests to determine medical necessity.
      • Monitoring of provider performance
      • Recommending departmental improvements
    • Resource for Medical Management staff for care coordination and management for ambulatory and inpatient services
    • Acting as medical reviewer on appeals
    • Demonstrating collaboration with Virginia Premier staff and management to achieve goals and objectives of the department and organization


    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Current Unrestricted Virginia Physician License
    • Board Certified physician preferred

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Commitment to Virginia Premier’s clinical programs and mission to serve the Medicaid population
    • Ability to work with colleagues and other health care professionals to resolve utilization and quality management issues
    • Ability to communicate effectively with health professionals, administrators and staff, both orally and in writing
    • Ability to review the medical literature to answer a clinical question
    • Basic computer skills

    WORK BACKGROUND/EXPERIENCE

    • Minimum of five years clinical experience
    • Two or more years experience in managed care medical management preferred

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position.

      

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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