Wisconsin Staffing
Associate Medical Director
Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. Network Health is seeking an Associate Medical Director. The Associate Medical Director is responsible for the administration of procedures, protocols, and standards regarding the efficiency and quality of the health care delivered to Network Health Plan (NHP) members. Demonstrate commitment and behavior aligned with the philosophy, mission, values, and vision of Network Health. Appropriately apply all organizational and regulatory principles, procedures, requirements, regulations, and policies. Conduct oneself in a manner which promotes quality and service excellence for clients, members, physicians, staff, and visitors and contributes to the spirit of teamwork within Network Health, Inc. (NHI). Assist the Chief Medical Officer (CMO) with monitoring availability, appropriateness, and necessity of care rendered by participating providers and by out-of-plan providers. Participate in the daily operations of the UM program including but not limited to rendering denial determinations for services not considered medically necessary or experimental/investigation/unproven in accordance with regulatory and quality standards. Contribute to the development of quality care guidelines, internal peer review procedures, and the evaluation of medical care evaluation studies under the NHP quality assurance programs. In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality assessment processes. Promote positive relationship between NHP and medical community. Serve as liaison between NHP and providers regarding matters of medical policy and medical administration. Serve as spokesperson for NHP in the medical community and maintain appropriate contact with professional health care organizations. Participate in the ongoing recruitment of plan physicians. Assist in the development of appropriate medical guidelines and parameters for claims review. Assist in the training of NHP staff on matters relating to medical guidelines. Work closely with Utilization Management team as part of first level claims review. Serve on committees as coordinated with the CMO. Assist in strategic planning targeted towards plan growth initiatives. Performs other duties and responsibilities as assigned. Management courses or courses in managed care preferred. Participation in management committees in a practice or hospital setting required. Experience as a medical director preferred. Experience and knowledge of managed care principals, utilization management, case management, quality, and population health preferred.
Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. Network Health is seeking an Associate Medical Director. The Associate Medical Director is responsible for the administration of procedures, protocols, and standards regarding the efficiency and quality of the health care delivered to Network Health Plan (NHP) members. Demonstrate commitment and behavior aligned with the philosophy, mission, values, and vision of Network Health. Appropriately apply all organizational and regulatory principles, procedures, requirements, regulations, and policies. Conduct oneself in a manner which promotes quality and service excellence for clients, members, physicians, staff, and visitors and contributes to the spirit of teamwork within Network Health, Inc. (NHI). Assist the Chief Medical Officer (CMO) with monitoring availability, appropriateness, and necessity of care rendered by participating providers and by out-of-plan providers. Participate in the daily operations of the UM program including but not limited to rendering denial determinations for services not considered medically necessary or experimental/investigation/unproven in accordance with regulatory and quality standards. Contribute to the development of quality care guidelines, internal peer review procedures, and the evaluation of medical care evaluation studies under the NHP quality assurance programs. In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality assessment processes. Promote positive relationship between NHP and medical community. Serve as liaison between NHP and providers regarding matters of medical policy and medical administration. Serve as spokesperson for NHP in the medical community and maintain appropriate contact with professional health care organizations. Participate in the ongoing recruitment of plan physicians. Assist in the development of appropriate medical guidelines and parameters for claims review. Assist in the training of NHP staff on matters relating to medical guidelines. Work closely with Utilization Management team as part of first level claims review. Serve on committees as coordinated with the CMO. Assist in strategic planning targeted towards plan growth initiatives. Performs other duties and responsibilities as assigned. Management courses or courses in managed care preferred. Participation in management committees in a practice or hospital setting required. Experience as a medical director preferred. Experience and knowledge of managed care principals, utilization management, case management, quality, and population health preferred.