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Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm

Company: SmartDocs Direct
Location: Des Moines
Posted on: January 16, 2020

Job Description:

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

Position Purpose: Assist the Chief Medical Director to
direct and coordinate the medical management, quality improvement and
credentialing functions for the business unit.

  • Provides
    medical leadership of all for utilization management, cost containment,
    and medical quality improvement activities. Performs medical review
    activities pertaining to utilization review, quality assurance, and
    medical review of complex, controversial, or experimental medical
    services. Supports effective implementation of performance improvement
    initiatives for capitated providers.

  • Assists Chief Medical
    Director in planning and 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.

  • Assists the
    Chief Medical Director in the functioning of the physician committees
    including committee structure, processes, and membership. Oversees the
    activities of physician advisors. Utilizes the services of medical and
    pharmacy consultants for reviewing complex cases and medical necessity
    appeals. Participates in provider network development and new market
    expansion as appropriate. Assists in the development and implementation
    of physician education with respect to clinical issues and policies.


  • 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.
    Interfaces with physicians and other providers in order to facilitate
    implementation of recommendations to providers that would improve
    utilization and health care quality. Reviews claims involving complex,
    controversial, or unusual or new services in order to determine medical
    necessity and appropriate payment.

  • Develops alliances with
    the provider community through the development and implementation of the
    medical management programs. As needed, may represent the business unit
    before various publics both locally and nationally on medical
    philosophy, policies, and related issues. Represents the business unit
    at appropriate state committees and other ad hoc committees

  • Consults on MCO clinical policy related to Substance Use Disorders and
    the cases of individual members for the MCM program on a routine basis.


  • Education/Experience: Medical Doctor or Doctor of
    Osteopathy, board certified preferable in a primary care specialty
    (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine).
    The candidate must be an actively practicing physician. Previous
    experience within a managed care organization is preferred. Course work
    in the areas of Health Administration, Health Financing, Insurance,
    and/or Personnel Management is preferred. Experience treating or
    managing care for a culturally diverse population preferred.

Keywords: SmartDocs Direct, Des Moines , Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm, Healthcare , Des Moines, Iowa

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