Chief Medical Officer, Specialty

Maryland Heights MO 63043 St Louis 1 14100 Magellan Plaza

Job Description

This position is responsible for all medical aspects of an assigned SBU. These aspects include, but are not limited to, medical policy, medical quality assurance, oversight of utilization management (UM), credentialing criteria for physician clinical reviewers and consultants, medical community relations and health plan medical relations. .
  • Leads clinically driven efforts to establish and maintain a current system to promote and achieve appropriate utilization for SBU product suite.
  • Supervises the establishment of clinical guidelines and parameters that best reflect appropriate utilization.
  • Establishes a process for ongoing maintenance of the clinical review criteria and guidelines.
  • Creates and supervise programs to educate referring and rendering practitioners on appropriate utilization.
  • Coordinates the implementation of guidelines with information management systems.
  • Promotes national recognition of SBU, staff and systems.
  • Reviews aggregate denials and appeals with appropriate groups (e.g., Medical Director, UM and Quality Compliance, etc.).
  • Chairs Utilization Management and Continuous Quality Improvement Committee.
  • Establishes a report mechanism and criteria for monitoring medical operations related to Client Services, Claims Processing, Quality Assurance and Continuous Quality Improvement.
  • Supervised ongoing relations with client-plan Medical Directors.
  • Supervised all articles published in educational newsletters and promote academic relationships as appropriate.
  • Publishes and reviews all articles related to or based on clinical information generated in the operation of SBU.
  • Participates in the sales effort of SBU in conjunction with the Chief Executive Officer and the goals of the Board of Directors.
  • Directs presentations, publications and speaking engagements consistent with the sales effort.
  • Monitors credentialing process of physician clinical reviewers and consultants.

General Job Information

Title

Chief Medical Officer, Specialty

Grade

37

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

2/7/2020

Date Requisition Created

2/7/2020

Work Experience

Medical

Education

DO (Required), MD (Required)

License and Certifications - Required

DO - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician, MD - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Practical experience with managed care organizations and health care reform.
  • Knowledge of health care systems and desire to effect appropriate changes.
  • Experience with cost-benefit analysis, medical decision analysis, credentialing, quality assurance and continuous quality improvement (CQI) processes.
  • History of significant participation with medical organizations and business development.
  • Strong organization, management and leadership skills.
  • Minimum of 10 years' experience providing direct patient care.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”

Haita Makanji VP of Clinical Strategy and Programs at Magellan MRx