Associate Medical Director
Location: Nashville, Tennessee
Description: State of Tennessee is at the momment seeking for Associate Medical Director right now, this vacancy will be settled in Tennessee. More complete informations about this vacancy opportunity kindly read the description below. TennCare is Tennessee’s Medicaid managed care program that provides health insurance coverage for 1.2 million low income children, adult caretakers of children, pregn! ant women and disabled adults. TennCare currently covers one out of every five Tennesseans and 50% of Tennessee births and has an annual budget of $9 billion.
All TennCare members are enrolled in a managed care organization (MCO) that administers an integrated physical, behavioral and long term care benefit. MCOs operate under full risk contracts and are required to be NCQA accredited. Pharmacy and dental benefits are “carved out†and administered by a pharmacy benefits manager (PBM) and dental benefits manager (DBM).
The Associate Medical Director functions as a key member of TennCare’s Chief Medical Officer Team, supporting the ultimate goal of promoting the delivery of high quality services within a sustainable budget. Responsibilities will include:
- Monitoring the quality of services provided to enrollees by the contracted managed care organizations (Physical, Behavioral and Long-Term Care).
- Serving as a liaison and contact w! ith the medical leadership of the contracted Managed Care Orga! nizations
- Interacting on a regular basis with MCO medical directors and clinical and non-clinical staff in other state agencies including the Departments of Health, Intellectual Disabilities, Children’s Services, and Mental Health and Substance Abuse Services.
- Analyzing proposed legislation and testifying at legislative committee.
- Serving as a liaison to the healthcare provider community.
- Monitoring reports relevant to court orders and consent decrees.
- Overseeing contracts with external agencies and professional organizations.
- Supporting collaborative efforts for Electronic Health Record (EHR)-related activities, including incentive grant program and health information exchange.
- Reviewing clinical cases involving medical appeals, eligibility for Emergency Medical Assistance, and children with health problems that put them at risk of entering state custody.
- Intervening in disputes between Managed Care Companies and the TennCare Appeals Unit.
- Monitoring pharmacy utilization, including participation in activities related to retrospective drug utilization review.
- Participating in multiple medical committees including the Pharmacy Advisory Committee and the Drug Utilization Review Board.
- Representing TennCare on other external committees.
- Interacting with the pharmacy, oral health, quality oversight teams, provider services, and enrollee services.
- Participating in the development and implementation of Payment Reform programs
Licensure: Must be a Physician licensed in Tennessee (or eligible)
Qualifications/Experience : Board certified in pediatrics, ! family medicine or internal medicine preferred with significant clinica! l experience. Experience in managed care, including utilization management and quality improvement is highly desirable; however, administrative experience in an alternative setting such as a hospital system or state Medicaid agency will be considered. Familiarity with the design and operation of Medicaid. Excellent oral and written communication skills; strong organizational, time management, interpersonal and computer skills.
Salary Range : $140,000-$160,000 depending on qualifications and experience.
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to State of Tennessee.
Interested on this vacancy, just click on the Apply button, you will be redirected to the official website
This vacancy will be opened on: Tue, 01 Oct 2013 19:59:18 GMT
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