Maxim Physician Resources offers all our providers competitive weekly pay, direct deposit, paid medical malpractice, paid travel and lodging, nationwide commercial and government, moonlighting, locum tenens, and permanent placement.
Position Details:
1. Assists in managing medical costs and assuring appropriate health care delivery for Amerigroup health plans, products and services.
2. Provides guidance, support and leadership for utilization management activities.
3. Supports Medical Director(s) in all aspects of utilization, quality and network management.
4. Provides support to nurses and clinical leaders in pre-authorization, concurrent and retrospective review decisions, case management and disease management decisions.
5. Assists Medical Directors and/or National Medical Directors with medical policy; participates in policy review, reviews trends and makes recommendations; may plan, organize and/or direct medical services programs, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.
6. Assists in the design and implementation of corrective action plans to address issues and improve plan and network managed care performance.
7. Supports URAC, AHCA and NCQA qualification activities. Prepare for site visits and responds to accrediting and regulatory agency feedback.
8. Participates in risk management, claims adjudication, utilization management, catastrophic case review, education and outreach programs, HEDIS reporting, credentialing, peer to peer review, appeals review, denials, etc.
9. Participates in the development of strategic planning for existing and expanding business. Recommends changes in program content in concurrence with changing markets and technologies.
10. Other duties as assigned or requested
For more details on this position or one of our other opportunities throughout the country please contact Maxim Physician Resources today at 972-729-2590 or via email dudarakh@maxhealth.com
