Interact with and coordinates appropriate scientific and medical activities with internal stakeholders (i.e. commercial, clinical operations, discovery, statistics, regulatory, etc) as they relate to on-going medical affairs projects.
Leads the medical team for assigned clinical trials to design, implement, conduct and interpret clinical studies to support decisions to advance or halt development of a new drug or to successful filing regulatory submissions.
The Medical Director of Psychiatry supervises and coordinates the activities of our Behavioral Health psychiatrists and physicians. This leader serves as liaison between the psychiatric medical staff and the administration as well as providing psychiatric services to clients.
The preferred candidate will be a patient focused team player with demonstrated leadership experience, excellent interpersonal communication skills, a strong work ethic, and the ability to successfully collaborate with colleagues in successfully implementing change initiatives.
In this role, the selected candidate will provide strategic leadership and guidance in medical management and quality across all Medicare Advantage Plans. Ensure compliance with all Centers of Medicare/Medicaid Services (CMS) clinical, quality, and service requirements and ensure a centralized structure to support the Medicare business unit.
Develop policies and procedures, and standard operating procedures that will provide a consistent approach to clinical appeal medical director adjudication processes for the clinical appeal departments across all three business segments.
Conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed in peer-to-peer telephone calls.
The ideal candidate will bring attributes of an entrepreneurial thinker and boots-on-the-ground activist seeking to initiate innovate care models, a proactive approach to designing and launching member health improvement initiatives, applying healthcare informatics to strategic analysis and decision-making and an operational strategy of how to implement this vision.