Company: KEPRO (The Keystone Peer Review Organization), Inc
Posted on: April 9, 2021
If you are a job seeker with a disability and require a
reasonable accommodation to apply for one of our jobs, you will
find the contact information to request the appropriate
accommodation by visiting the following page: KEPRO is a rapidly
growing national quality improvement and care management
organization. We work to ensure that over 20 million people receive
the right care, at the right time, in the right setting.--KEPRO is
seeking resumes for a highly experienced professional.
- Oversee the clinical aspects of external quality review
- Provide technical assistance as requested by KEPRO or the
- Complete desktop evaluations for each of the PIP worksheets
submitted by the PHPs in accordance with the scoring criteria
included in the Validation of PIP Methodology rating form.
- Conduct and participate in the documentation of an evaluation
that includes a review of each PIP worksheet for clarity of project
purpose and integrity of project methodology and a corresponding
rating of each PIP with respect to the review standards included in
the PIP methodology review document.
- Consult with the Lead Performance Improvement Project Reviewer
on the findings for each PIP review
- Engage in telephonic discussion and defense of the PIP ratings
with PHP staff and product managers; post-discussion revisions to
the PIP ratings, as indicated; and consultation with state staff as
- Assist KEPRO staff in identifying areas for further quality
reviews, education, and technical assistance.
- Allocate and coordinate clinical staff as needed to perform all
- Serve as a liaison between the Contractor and the state
Business Intelligence Office team. The list of accountabilities is
not intended to be all-inclusive and may be expanded to include
other duties that management may deem necessary from time to time.
- 10 years' experience providing direct patient care
- Prior Medicaid experience
- Current, valid, unrestricted license to practice medicine in
the State of North Carolina Knowledge, Skills, Abilities
- Strong knowledge in quality assurance and utilization review is
- Contemporary clinician who understands major trends in
healthcare and managed care.
- Ability to work effectively with a diversity of personalities.
Must be approachable; show respect for others, and a consensus
- Systems thinker with strong organizational skills who can pull
all the pieces together and deliver on time and within budget.
- Adaptable with strong collaborative management style, a
creative thinker with high energy and enthusiasm, and a team player
who promotes the concepts of people working together.
- Able to adapt to frequently changing work parameters.
- 10+ years of clinical practice preferred.
- 5-7 years of experience as a physician executive with
significant accomplishments in developing managed care strategies,
integrating delivery systems, improving quality and utilization
management programs and coaching medical staff on healthcare
business and practice issues.
- Minimum 2 years as a Medical Director in a managed care company
- Experience in Utilization Management, Case and Disease
Management with knowledge of Medicaid and Medicare programs.
- Prior review experience or quality assurance committee
responsibility in a hospital setting preferred. Mental and Physical
Requirements The physical demands described here are representative
of those that must be met by an employee to successfully perform
the essential functions of this job. Reasonable accommodations will
be made as required by law in an attempt to enable an individual
with a disability to perform the essential functions of this job.
While performing the duties of this job, the employee is regularly
required to sit for prolonged periods of time; key and/or control
objects; interact extensively with internal and external customers;
occasionally lift and/or move objects weighing up to 10 pounds; and
occasionally travel within the state. KEPRO offers challenging
careers, excellent benefits and opportunities for advancement. For
consideration, please submit resume and cover letter with salary
requirements.--Only those candidates identified for an interview
will be contacted.--No Phone Calls Please. Visit our website at
www.KEPRO.com for more information on the KEPRO Family of
Companies. EOE AA M/F/Vet/Disability KEPRO is an E-Verify employer.
E-Verify is an internet based system operated by the Department of
Homeland Security (DHS) in partnership with the Social Security
Administration (SSA) that allows participating employers to
electronically verify the employment eligibility of their newly
hired employees in the United States. Equal Opportunity
Employer/Protected Veterans/Individuals with Disabilities The
contractor will not discharge or in any other manner discriminate
against employees or applicants because they have inquired about,
discussed, or disclosed their own pay or the pay of another
employee or applicant. However, employees who have access to the
compensation information of other employees or applicants as a part
of their essential job functions cannot disclose the pay of other
employees or applicants to individuals who do not otherwise have
access to compensation information, unless the disclosure is (a) in
response to a formal complaint or charge, (b) in furtherance of an
investigation, proceeding, hearing, or action, including an
investigation conducted by the employer, or (c) consistent with the
contractor's legal duty to furnish information. 41 CFR
Keywords: KEPRO (The Keystone Peer Review Organization), Inc, Raleigh , Medical Director, Executive , Raleigh, North Carolina
Didn't find what you're looking for? Search again!