Associate Medical Director

Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. Network Health is seeking an Associate Medical Director. The Associate Medical Director is responsible for the administration of procedures, protocols, and standards regarding the efficiency and quality of the health care delivered to Network Health Plan (NHP) members.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is require). Travel may be required occasionally for the position.

Hours: 0.5 FTE, 8am - 5pm Tuesday, Thursday, and Friday

Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

• Demonstrate commitment and behavior aligned with the philosophy, mission, values, and vision of Network Health
• Appropriately apply all organizational and regulatory principles, procedures, requirements, regulations, and policies
• Conduct oneself in a manner which promotes quality and service excellence for clients, members, physicians, staff, and visitors and contributes to the spirit of teamwork within Network Health, Inc. (NHI)
• Assist the Chief Medical Officer (CMO) with monitoring availability, appropriateness, and necessity of care rendered by participating providers and by out-of-plan providers
• Participate in the daily operations of the UM program including but not limited to rendering denial determinations for services not considered medically necessary or experimental/investigation/unproven in accordance with regulatory and quality standards
• Contribute to the development of quality care guidelines, internal peer review procedures, and the evaluation of medical care evaluation studies under the NHP quality assurance programs. In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality assessment processes
• Promote positive relationship between NHP and medical community
• Serve as liaison between NHP and providers regarding matters of medical policy and medical administration
• Serve as spokesperson for NHP in the medical community and maintain appropriate contact with professional health care organizations
• Participate in the ongoing recruitment of plan physicians
• Assist in the development of appropriate medical guidelines and parameters for claims review
• Assist in the training of NHP staff on matters relating to medical guidelines
• Work closely with Utilization Management team as part of first level claims review
• Serve on committees as coordinated with the CMO
• Assist in strategic planning targeted towards plan growth initiatives
• Performs other duties and responsibilities as assigned

Job Requirements:

• Doctor of Medicine (MD or DO), licensed in the state of Wisconsin without restriction
• Management courses or courses in managed care preferred
• Participation in management committees in a practice or hospital setting required
• Experience as a medical director preferred
• Experience and knowledge of managed care principals, utilization management, case management, quality, and population health preferred

Network Health is an Equal Opportunity Employer