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Administrative Physician - Physicians Only Apply - Perm

Company: Necnic Group, LLC
Location: Des Moines
Posted on: August 16, 2019

Job Description:

A Administrative Physician practice is seeking a qualified physician for Des Moines, IA. This and other physician jobs brought to you by ExactMD. Medical Doctors Only Apply.




Des Moines, IA - Medical
Director (Behavioral Health) Position Purpose: Assist the VP of Clinical Programs to direct
and coordinate the physician component of the utilization management functions
for the health plan business units.

--- Provides medical leadership for utilization management activities and medical
review activities pertaining to utilization review, quality assurance, medical
review of complex, and controversial or experimental medical services such as
transplants utilizing the services of consultants



--- Performs case reviews and appeals for all health plans.



--- Assists VP of Clinical Programs in planning, 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.



--- 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.



--- Reviews claims involving complex, controversial, or unusual or new services
in order to determine medical necessity and appropriate payment


Education/Experience: Board certification by the American
Board of Psychiatry and Neurology. Experience treating or managing care for a
culturally diverse population preferred. Minimum of 5 years clinical experience.
The candidate must be an actively practicing physician.


License/Certifications: Board Certification through American
Board Medical Specialties. Current state medical license without restrictions.


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Keywords: Necnic Group, LLC, Des Moines , Administrative Physician - Physicians Only Apply - Perm, Administration, Clerical , Des Moines, Iowa

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