my responsibilities as a medical director
TRANSCRIPT
My Responsibilities as a Medical Director
1. Take a leadership role in customer facing activities including innovations that move the business unit strategy forward
2. Lead the interface with Health Plan leaders and Provider organization leaders as indicated
3. Lead all healthcare Integration activities
4. Take a leadership role in NCQA readiness/review
5. Provide oversight, consultation, and direction for all site medical/clinical activities
6. Provide medical/clinical expertise in strategies for integrated behavioral health & physical care
7. Lead the Regional Network Credentialing Committee
8. Provider performance evaluations, review quality of care concerns and sentinel events
9. Perform legal audits as required
10. Lead and participate in the implementation of the MD/PA Model Measurements
11. Work with the legal department, quality department and the customer to manage escalated/ high profile/ high risk cases
12. Lead clinical rounds, case consults for clinical teams
13. Manage the process of case referral (including appeals) to physicians
14. Conduct audits quarterly as required
15. Manage and train all Physician Advisors
16. Conduct peer reviews, appeals, and consultations with providers
17. Advance knowledge and understanding of the provider network and cultivate provider relationships
18. Participate in provider review activities with the Network Department Measurements
19. Work closely with The Medical Society of Virginia & The Psychiatric Society of Virginia to better understand the needs of the provider community
20. Identify high quality providers that are willing and able to serve on committees and provide feedback from the community
21. Supervise and manage MCO Liaison and oversee collaboration with other MCOs
22. Take accountability for Clinical and Quality performances goals and all utilization targets, set by the CMC annually for all lines of business. This includes all HEDIS measures required for NCQA.
23. Participate in the analysis of over and underutilization and will contribute to the development of clinical strategies to address problematic trends measurements
23. Take a leadership role in developing clinical strategies in the account market to improve any other clinical metric targeted in over and underutilization analyses