Medical Director - Full-time with Tennessee License (Remote U.S.)

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary:

• Provides the principal leadership and clinical expertise to operations on all medical aspects relating to the peer review process, utilization review activities, case management, and other activities requiring clinical leadership and consultation. Additional key responsibilities may include assisting and promoting business development and strategic planning activities.

Responsibilities:

• Support the planning, direction, implementation, analysis, and reporting of medical management for Contractor and TennCare; develop, implement, and manage standards, benchmarks, trending, and profiling systems; oversee achievement of program targets.
• Evaluate, redirect and/or respond to inquiries from physicians, providers, and TennCare.
• Consult with reviewer and witness panel members as business needs require.
• Represent and promote Acentra Health at seminars, professional societies, hospital medical staff meetings, and other professional settings as appropriate.
• Support provider education and contracting arrangements; assist training of the provider networks.
• Foster appropriate external relationships with attending physicians/surgeons by response to telephone calls and letters, speaking engagements before physician and provider organizations.
• Provide leadership and support for design, development, and implementation of new products and services.
• Analyze and remain current on national, state, and local regulations and legislation, which impacts the health care profession.
• Review medical information trends, experiences, and approaches, and assist in the development of strategic plans for clinical improvements.
• Ensure compliance with regulatory and accreditation requirements.
• Provide oversight of medical content of company publications.
• Participate in activities specific to contractual arrangements, i.e., Fair Hearings, Committees and Project Meetings of Contractor.
• Provide medical expertise with respect to planning and establishing goals and policies to improve medical management.
• Provide guidance to management on the performance and direction of Contractor.
• Provide oversight of physician consultants and advisors. Conduct peer-to-peer physician consultations as requested/required; document consultations.
• Work with medical, nursing, and administrative staff to identify matters needing shared attention.
• Interface and coordinate with TennCare.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Required Qualifications/Experience:

• M.D. or D.O. with a current or eligibility for a non-restricted license to practice medicine by the Tennessee Board of Medical Examiners.
• Board Certified in a clinical specialty.
• 10+ years of clinical practice.
• Experience in Medicaid and Medicare.
• Knowledge of complex health care systems and delivery systems.

Preferred Qualifications/Experience:

• Experience as a primary care physician or a specialist managing chronic diseases.
• Prior review experience or quality assurance committee responsibility in a hospital setting.
• 5+ years of experience as a Medical Director of a complex managed care organization.
• Experience relating to certification and regulatory agencies.
• Advanced knowledge of complex medical, technical, statistical and process components relating to utilization review, quality management, case management and health field business.
• Strong comprehension skills to analyze and interpret technical reports and abstract concepts at an advanced level.
• Tennessee residency.

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Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra Health

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."