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Medical Director

Company: KEPRO (The Keystone Peer Review Organization), Inc
Location: Raleigh
Posted on: April 9, 2021

Job Description:

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. Accountabilities

  • Oversee the clinical aspects of external quality review activities.
  • Provide technical assistance as requested by KEPRO or the State
  • 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 needed.
  • Assist KEPRO staff in identifying areas for further quality reviews, education, and technical assistance.
  • Allocate and coordinate clinical staff as needed to perform all EQRO-related activities.
  • 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. Qualifications
    • 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 required.
      • 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 builder.
      • 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. Experience
        • 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 preferred.
        • 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 60-1.35(c)

Keywords: KEPRO (The Keystone Peer Review Organization), Inc, Raleigh , Medical Director, Executive , Raleigh, North Carolina

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