Emergency Medicine Opening in Janesville, WI
Saint Louis, Missouri, United States
Job Summary
Occupation
Physician
Specialty
Emergency Medicine
Degree Required
MD/DO
Position Type
Full-Time
Work Environment
Hospital
Clinic/Private Practice
Location
Janesville, Wisconsin, United States
Visa Sponsorship
No
Job Description
Last Update:
2/21/25
Medical Director opening in Southern WI
Located in Janesville, WI - Milwaukee 75m, Chicago 105m
Full-time, permanent position
Employed opportunity
Responsibilities include:
Overseeing all initiatives and ongoing work in clinical programs, NCQA, HEDIS, credentialing, compliance with federal and state regulations, and management of grievance and appeal processes.
Constantly evaluating and benchmarking of the resource-management system including utilization and case management.
Monitoring/reviewing treatment recommendations by participating and non-participating providers for quality, appropriateness, and cost-effectiveness.
Monitoring the constantly changing provision of care environment for changes in technique, technology, and protocols, and providing recommendations regarding plan member services.
Reviewing quality-of-care issues and referring them to appropriate parties.
Providing leadership and communication to physician groups and our leadership on care quality and efficiency issues.
Staffing/chairing the Medical Management Committee and its subcommittees.
Acting as NCQA project leader and providing management support for managed-care accreditation programs.
Required Credentials:
Status as a medical doctor with appropriate state licensure
Current board certification in primary care, specialty, or emergency medicine
Five or more years of experience in direct patient care
Five or more years of experience in managed care or similar administrative role