Requirements:

We are currently seeking a Board Certified M.D. (preferably Board Certification in primary care) with a current unrestricted license to practice medicine in the District of Columbia, to serve as Associate Medical Director of Utilization Management, on a part-time basis. The Director is responsible for ensuring the effective utilization of medical services, making Medical Necessity determinations, conducting utilization review and overall quality evaluation of requested medical and surgical services and hospital stays including concurrent and prospective inpatient stays. Also assists with the coordination of the appeal process for denied services, including making appeal determinations.

Requirements include:

·         Ability to organize, document, develop, monitor and control high quality health care in a prepaid setting through contractual relationships between the MCO and primary, secondary and tertiary care providers and other non-contractual relationships with local and national providers and professional health care organizations.

·         An understanding of the socioeconomic and health care problems of low income groups in a large metropolitan area, particularly of Medicaid beneficiaries and of the District of Columbia.

• Thorough knowledge of medical quality management techniques and their applications: NCQA, JACHO, URAC and HEDIS.

·         Minimum (5) years experience in clinical practice, 3-5 years experience in a managed care environment and 2-3 years experience in utilization management, utilization reviews and application of clinical guidelines.