Medical Director

Job Summary

Priority Health is seeking a Medical Director. This position is critical to Priority Healths mission of improving health inspiring hope and saving lives as we partner with medical communities. Expectations will include : A strong understanding of the guiding principles of; Right care Right time Right place Right cost. This strong understanding of the guiding principles will be demonstrated through applications of evidence-based utilization review process and application of sound clinical judgement. The medical director will be part of the medical director teams and will work jointly with each of the lines of business leaders to assure compliant evidence-informed decisions are provided. This position will have responsibilities including peer to peer clinical discussions and participation in denials management which include review of previous clinical decisions by Priority Health Medical Directors (appeals). There will be opportunities to clinically contribute to discussions specific to populations health topics. Expectation to maintain Board Certification in a Medical or Surgical specialty from a nationally recognized specialty board. This position will be a strong contributor to support the mission and vision of Priority Health.

Essential Functions

Understand Priority Healths mission strategic goals and value proposition for our communities and the people we serve.

Actively participate in support of medical management

Provide clinical oversight to nurse case management and utilization management.

Promote and advocate for patient-centered care evidence-based medicine and lower per-capita costs; participate in the development of clinical utilization guidelines health management programs and clinical quality programs.

Promote evidence-base care standards with our community physician partners.

Qualifications

Required Doctorate

3 years of relevant experience in clinical setting Required

3 years of relevant experience Managed care experience Required

Proven experience and evidence of success in effective physician communication and education skills; evaluation of evidence-based standards of care and application of utilization management skills and strategies. Preferred

LIC-Physician (MD) - STATEMI State of Michigan required Or

LIC-Osteopathic Physician (DO) - STATEMI State of Michigan required

About Corewell Health

As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement - to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

Comprehensive benefits package to meet your financial health and work / life balance goals. Learn more here.

On-demand pay program powered by Payactiv

Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!

Optional identity theft protection home and auto insurance pet insurance

Traditional and Roth retirement options with service contribution and match savings

Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

PH - Medical Affairs

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 : 00 a.m. to 5 : 00 p.m.

Days Worked

Monday to Friday (weekend rotation)

Weekend Frequency

Variable weekends

CURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.

An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.

Required Experience :

Director

Key Skills

EMR Systems,Post Residency Experience,Occupational Health Experience,Clinical Research,Managed Care,Primary Care Experience,Medical Management,Utilization Management,Clinical Development,Clinical Trials,Leadership Experience,Medicare

Experience : years

Vacancy : 1