Associate Medical Director (M.D./D.O.)
Company: KEPRO
Location: Nashville
Posted on: May 28, 2023
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Job Description:
Associate Medical Director
Are you an experienced Associate Medical Director looking for a new
challenge?
Do you value care management and quality improvement?
Are you motivated, energetic, and excited to become part of the
Kepro team?
If so, you might be our next new team member!
Who we need:
The Associate Medical Director assists as directed by the Medical
Director and in the Medical Director's absence assumes clinically
related duties.
Why us?
Kepro is a rapidly growing national quality improvement and care
management organization. We work to ensure that over 20 million
people receive the right care, at the right time, in the right
setting.
People Focused. Mission Driven.
Shape the future of healthcare with us. We are mission driven to
improve lives through healthcare quality and clinical
expertise.
We do this through our people.
At Kepro, you can do meaningful work that makes a real difference
for the lives of individuals across the country. We are an
organization that cares deeply about our employees and we provide
the training and support to do the best work of your career.
Benefits are a key component of your rewards package at Kepro.
These benefits are designed to provide you and your family
additional protection, security, and support for both your career
and your life away from work. They are comprehensive and fit a
variety of needs and situations. Our benefits include comprehensive
health plans, paid time off, retirement savings, corporate
wellness, educational assistance, corporate discounts and more.
What you'll do:
Prepares independent reviews of medical services appeals
Reviews records, prepares and submits all reviews in a timely
manner in keeping with the TennCare/KEPRO contractual due dates.
These may include appeals by TennCare members, Department of
Intellectual & Developmental Disabilities clients, and Department
of Commerce & Insurance appeals from TennCare providers.
Critically evaluates the application of guidelines and protocols by
the TennCare managed care organizations, dental benefits manager,
and pharmacy benefits manager to the individual enrollee's appeal.
Takes into consideration TennCare Rules of Medical Necessity,
standards of care, evidence-based medicine, and hierarchy of
evidence.
Provides expert medical witness testimony for the State in appeals
hearings
Systematically reviews medical necessity reviews and all available
medical records
Reviews relevant peer reviewed research and evidence-based sources
as needed
Consults with the assigned TennCare attorney prior to the hearing
as needed
Ensures the quality of reviews and hearing testimony
Edits Medical Necessity Reviews authored by other reviewers
Oversees quality assurance activities for medical necessity reviews
and hearing outcomes
Updates appropriate TennCare staff on current medical practice as
needed
Regularly reviews relevant topics via peer reviewed articles and
evidence-based sources to identify changes in medical practice,
treatments, and medications
Works with medical, nursing, and administrative staff to identify
matters needing shared attention
Evaluates, redirects, and/or responds to inquiries from physicians,
providers, and clients
May primarily work remotely but must be available onsite to the
client as contractually required
The list of accountabilities is not intended to be all-inclusive
and may be expanded to include other education- and
experience-related duties that management may deem necessary from
time to time.
What you'll need:
Required Qualifications
M.D. or D.O. with current non-restricted license to practice
medicine by the Tennessee Board of Medical Examiners.
Current board certification in a clinical specialty is required.
Internal medicine, pediatrics, or family medicine preferred
Working knowledge of quality assurance and utilization review is
required.
Knowledge, Skills, Abilities
Ability to work effectively with a diversity of personalities. Must
be approachable, show respect for others, and a consensus
builder.
Adaptable with strong collaborative management style, a creative
thinker with high energy and enthusiasm, and a team player who
promotes the concepts of people working together.
Excellent writing skills and proficient with MS Office Suite
Experience
5+ years of clinical practice.
Experience with Medicaid/Medicare
Prior managed care/utilization review work experience
Prior personnel management work experience
Thank You!
We know your time is valuable and we thank you in advance for
applying for this position. Due to the high volume of applicants we
receive, only those who are chosen to advance in our interview
process will be contacted. We sincerely appreciate your interest in
Kepro and invite you to apply to future openings that may be of
interest. Best of luck in your search!
- The Kepro Talent Acquisition Team
Mental and Physical Requirements
The physical demands described here are representative of those
that must be met by an employee to successfully perform the
essential functions of this job. Reasonable accommodations will be
made as required by law in an attempt to enable an individual with
a disability to perform the essential functions of this job. While
performing the duties of this job, the employee is regularly
required to sit for prolonged periods of time; key and/or control
objects; interact extensively with internal and external customers;
occasionally lift and/or move objects weighing up to 10 pounds; and
occasionally travel within the state.
EOE AA M/F/Vet/Disability
Kepro 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, or status as a protected veteran.
Keywords: KEPRO, Nashville , Associate Medical Director (M.D./D.O.), Healthcare , Nashville, Tennessee
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