Job Description

The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost effective medical care is received. Responsible for developing and implementing programs to improve quality, cost, and outcomes. This role will provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations..

Location: This is a hybrid position and will require 1 day per week in the office. Nashville is the preferred location and Tennessee residency is required.

How you will make an impact:

Supports clinicians to ensure timely and consistent responses to members and providers.

Provides guidance for clinical operational aspects of a program.

Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patient office visits with providers and external physicians. May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.

Serves as a resource and consultant to other areas of the company. May be required to represent the company to external entities and/or serve on internal and/or external committees. May chair company committees and be responsible for an entire clinical program.

Interprets medical policies and clinical guidelines. May develop and propose new medical policies based on changes in healthcare.

Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.

Identifies and develops opportunities for innovation to increase effectiveness and quality.

Minimum Requirements:

Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS), American Osteopathic Association (AOA) or National Board of Physicians and Surgeons (NBPAS).

Must possess an active unrestricted medical license to practice medicine or a health profession.

Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Per state contract requirements, must be a board-certified psychiatrist in the State of Tennessee.

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