Associate Medical Director

Overview

To oversee the appropriateness and quality of care delivered through Partnership HealthPlan of California and for the cost-effective utilization of services.

Responsibilities

• Performs Treatment Authorization Request (TAR) review and appeals to determine medical

necessity, appropriateness of services, interprets benefits and limitations, and reviews

claims, which are questionable in dollar amount or volume or scope of services. Assures

that care is at all times at an acceptable level of quality.

utilization.

daily support and appropriate direction to staff on issues pertaining to UM.

including criteria and guidelines for appropriate use of services, clinical practice guidelines

and treatment guidelines.

Credentials Committee and Internal Quality Improvement Committee as requested by the

Chief Medical Officer / May work with community provider committees and Advisory boards

on medical issues and policies.

Peer Review Committee.

Fair Hearings.

Qualifications

Education and Experience

Medical Doctor or Doctor of Osteopathy, plus completion of a residency program. Minimum of 5 years post-residency clinical experience.

Special Skills, Licenses and Certifications

California Medical License. Board Certification in an American Board of Medical Specialist Specialty. Understanding of outpatient clinical practice and hospital medicine. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Advanced computer skills, including proficiency in multiple software

applications including Microsoft Office. Ability to present data in local, concise manner. Ability to analyze complex medical issues.

Work Environment And Physical Demands

More than 50% of work time is spent in front of a computer monitor.

Must be able to work in a fast paced environment and maintain courtesy and composure.

All HealthPlan employees are expected to :

HIRING RANGE

$ 260,773.07 - $ 352,041.65

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.