Executive Director, Lead Medical Director
Triton Health SystemsBirmingham, AL, USjob_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
job_description.job_card.job_descriptionProvide direction and support while offering a quality medical perspective to the Medical Management department. Assist in developing and implementing operational processes, including but not limited to workflow changes, departmental documentation, and staff education to maximize departmental efficiency. Assist with the relationships between VIVA HEALTH and participating network physicians. This includes initiating discussions with physicians to make appropriate medical review decisions and responding to requests for discussion of cases, approval / denial decisions, etc. Provide assistance to the Provider Services department for physician education initiatives as needed. Provide support to internal staff in the Quality, Pharmacy, and Credentialing departments to create sound policies, procedures, and departmental goals. Act as Chair for corresponding committees when asked by the Vice President, Clinical Services. Aid in oversight and audits as needed. Administer best practices guidelines and provide guidance to Case Management for concurrent review. Assist in the development of medical necessity criteria on both new and / or uncommonly used drugs for use in coverage and denial decisions. Serve as a subject matter expert in the grievance process and provide official signoff for all denial decisions. Formulate and recommend cost containment ideas for patients in either an ambulatory or hospital setting. Provide internal decision support regarding medical necessity and over / under utilization of medical services in the VIVA HEALTH member population. Provide on-call coverage and assistance to nurses outside normal business hours to ensure required turnaround times are met. Maintain working knowledge of VIVA HEALTH Certificates of Coverage for its unique member populations and assist in ongoing document development. Medical degree from an accredited University 10 or more years clinical experience in direct patient care Management or Supervisory experience Current Physician license in good standing in the State of Alabama Board Certified Physician Ability to identify problems, collect data, establish facts, and draw valid conclusions Strong analytical, time management, and organizational skills; Ability to integrate diverse objectives with a high level of attention to detail Ability to read, analyze, and interpret various materials and effectively present information to individuals and groups; Effective oral and written communication skills Proficient in basic mathematical skills; Ability to read and explain graphs and charts Ability to read, analyze, and interpret procedures as well as government regulations; Ability to effectively present information and be persuasive in both one-on-one and group settings Ability to maintain favorable public relations while remaining sensitive to a variety of cultural, social, and educational backgrounds; Culturally sensitive with prior experience working with diverse groups on personal and financial issues; Skilled in discussion facilitation and problem solving Basic PC skills, including but not limited to Microsoft Word and Excel proficiency; Ability to use Electronic Health Record Knowledge of information and techniques needed to diagnose and treat human injuries, diseases, and deformities; This includes symptoms, treatment alternatives, drug properties and interactions, and preventative health care measures Knowledge of general medical principles and practices; Ability to assess and problem solve while working with a healthcare team; Ability to remain calm under stress Administrative and supervisory skills Experience in both inpatient and outpatient clinical settings Experience in managed care and / or population health
Job Description
Job Description
Executive Director, Lead Medical Director
Location : Birmingham, AL
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
- Comprehensive Health, Vision, and Dental Coverage
- 401(k) Savings Plan with company match and immediate vesting
- Paid Time Off (PTO)
- 9 Paid Holidays annually plus a Floating Holiday to use as you choose
- Tuition Assistance
- Flexible Spending Accounts
- Healthcare Reimbursement Account
- Paid Parental Leave
- Community Service Time Off
- Life Insurance and Disability Coverage
- Employee Wellness Program
- Training and Development Programs to develop new skills and reach career goals
- Employee Assistance Program
See more about the benefits of working at Viva Health - https : / / www.vivahealth.com / careers / benefits
Job Description
The Executive Director, Lead Medical Director is responsible for providing direction and support on medical, pharmaceutical, and quality issues related to the members of VIVA HEALTH. This position will oversee the Medical Directors and be involved in coordinating coverage for the utilization review team, the case management daily review for acute, transitions of care staff, post-acute care, and pharmacy redeterminations.
This role in collaboration with the Vice President, Clinical Services will co-chair the Utilization Management / Quality Improvement (UM / QI) committee, Credentialing Committee, and serve on other committees as needed. This position will prepare utilization data, high-cost trending, and collaborate with the facility partners at the quarterly Joint Operating Committee meetings and monthly clinical calls.
Key Responsibilities
REQUIRED QUALIFICATIONS :
PREFERRED QUALIFICATIONS :
serp_jobs.job_alerts.create_a_job
Executive Director • Birmingham, AL, US
Job_description.internal_linking.related_jobs
Requisition Number : DIREC002438.Locations : Birmingham, AL 35242, USA.Palmetto Infusion provides comprehensive ambulatory and home-based infusion services to both acute and chronically ill patients....serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Location : 70 Plaza Drive, Pell City, AL 35125.Pay : $81,000 - $95,000 salary + bonus.The Practice Manager III oversees the operations of an assigned medical practice.
In this role, the incumbent's pr...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Clinical Data Coordinator Job Duties : Support laboratory data management procedures including authoring and reviewi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Full Time Opportunity Available.Summer holiday, 1 Winter holiday.Physical Therapist Career Opportunity.Join a Team That Puts Your Passion for Care First Are you seeking a fulfilling c...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
Advance Your Nursing Leadership Career as an Assistant Director of Nursing (RN) at Baron House of Hueytown in Hueytown, AL!.
Are you an experienced RN with a passion for leadership and a drive for e...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Lead with Excellence as the Director of Nursing Services at Diversicare!.At Diversicare, we're in search of a dedicated Director of Nursing Services to join our exceptional team.If you're passionat...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days Whether you have your eye set on a specific hospital or found a place you'd love to call home, we can help.As the nation's largest healthcare staffing agency, we'll get you in the door faster throu...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days 
Host Healthcare is seeking a local contract nurse RN Manager for a local contract nursing job in Homewood, Alabama.Job Description & Requirements.
Pay package is based on 12 hour shifts and 36 h...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 Nursing Home Administrator At Diversicare.Lead with pride as a nursing home administrator at Diversicare! Join Diversicare and take the lead in shaping a culture of excellence in patient care, sati...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days 
COMPANY : Advanced Computer Learning Company, LLC.This position is contingent on contract aw.Integration & Development (SOCMID).
SOCMID plays a critical role in the preparation of Air Force Speci...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Advance Your Nursing Leadership Career as an Assistant Director of Nursing (RN) at Baron House of Hueytown in Hueytown, AL!.
Are you an experienced RN with a passion for leadership and a drive for e...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Physical Therapist Career Opportunity.Have you got the right qualifications and skills for this job Find out below, and hit apply to be considered.
Join A Team That Puts Your Passion For Care First....serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
Coosa Valley Medical Center (CVMC) is a progressive health care organization that believes in quality patient care and values their team members.
Below is an exciting opportunity to work with the am...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Weatherby can help you build a custom career plan, with multiple positions available for you today.Call us for specific details on your future job today.
Monday through Friday schedule 40 hours p...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day Full Time Opportunity Available PRN Opportunities Available Weekdays 7 : 45a-4 : 30p 1 Saturday per month 1 Summer holiday, 1 Winter holiday Physical Therapist Career Opportunity Join a Team...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours 
Host Healthcare is seeking a local contract nurse RN Manager for a local contract nursing job in Homewood, Alabama.Job Description & Requirements.
Host Healthcare Job ID #La1fVJ000007DYizYAG.Pay pac...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Join our dedicated team at Meadowview Nursing Center as a Registered Nurse Supervisor! Located at 7300 US Hwy 78 in Pell City, Meadowview Nursing Center is committed to providing high-quality care ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Full Time Opportunity Available PRN Opportunities Available Weekdays 7 : 45a-4 : 30p 1 Saturday per month 1 Summer holiday, 1 Winter holiday Physical Therapist Career Opportunity Join a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_less
Birmingham Va Health Care System.This position is located at the Birmingham VA Health Care System, within the Office of the Medical Center Director.serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days Full Time Opportunity Available PRN Opportunities Available Weekdays 7 : 45a-4 : 30p 1 Saturday per month 1 Summer holiday, 1 Winter holiday Physical Therapist Career Opportunity Join a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_less
- serp_jobs.job_card.promoted
Director of Patient Care Services
Aya HealthcareBirmingham, AL, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Practice Manager
Complete HealthPell City, AL, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Sr. Clinical Data Coordinator
TradeJobsWorkForce35135 Riverside, AL, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Medical (Physiotherapist)
Encompass HealthOneonta, AL, United Statesserp_jobs.job_card.full_time +1
- serp_jobs.job_card.promoted
Assistant Director of Nursing
Diversicare Healthcare Services Inc.Hueytown, AL, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Director of Nursing Services - RN
Diversicare Health CareBessemer, AL, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Permanent Executive Coordinator Non-Clinical - Administrative
Aya HealthcarePell City, AL, USserp_jobs.job_card.permanent
- serp_jobs.job_card.promoted
Local Contract Nurse RN - Manager
Host HealthcareHomewood, AL, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Licensed Nursing Home Administrator
Diversicare Health CareBessemer, AL, USserp_jobs.job_card.full_time
SOCMID Clinical Simulation Director
Advanced Computer Learning CompanyBirmingham, AL, USAserp_jobs.job_card.full_time
serp_jobs.filters_job_card.quick_apply
- serp_jobs.job_card.promoted
Assistant Director of Nursing (Hueytown)
Diversicare Healthcare Services Inc.Hueytown, AL, USserp_jobs.job_card.part_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Physical Therapist
Encompass HealthAlpine, Alabama, USserp_jobs.job_card.full_time +1
Director, Health Information Mgmt
Coosa Valley Medical CenterSylacauga, AL, United Statesserp_jobs.job_card.full_time
serp_jobs.filters_job_card.quick_apply
- serp_jobs.job_card.promoted
Locum Tenens Job Opportunity in Alabama for Family Practice Physician
HealthEcareers - ClientAlabama, AL, USAserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Physical therapist
Encompass HealthForestdale, AL, United Statesserp_jobs.job_card.full_time +1
- serp_jobs.job_card.promoted
Local Contract Nurse RN - Manager - $43-47 per hour
Host HealthcareHomewood, AL, United Statesserp_jobs.job_card.full_time
Registered Nurse Supervisor
Meadowview Nursing CenterPell City, AL, USAserp_jobs.job_card.full_time
serp_jobs.filters_job_card.quick_apply
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
15h Left! Medical (Physiotherapist)...
Encompass HealthVestavia Hills, AL, Jefferson County, AL; Alabama, USserp_jobs.job_card.full_time +1
- serp_jobs.job_card.promoted
Health System Administrator (Assistant Director)
US Government JobsBirmingham, AL, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Medical (Physiotherapist) (15h Left)...
Encompass HealthOneonta, AL, Blount County, AL; Alabama, USserp_jobs.job_card.full_time +1