Medical Director MLTC
New York, NY, USA | PRIDE Health
Industry:HR / Recruitment Services
Job Description:130 people have viewed this job
Organization is looking for a Medical .
Responsible for overseeing a Managed Long-Term Care program (MLTC), Fully Integrated Dual Advantage (FIDA) program, Institutional Special Needs Program (I-SNP) and Medicaid Advantage Plus program (MAP).
Oversees the quality assurance program.Chairs the Quality Assurance Committee, appoints its members and sets the agenda. Identifies opportunities for improvement and leads the development of projects to improve health outcomes.
Chairs the Medical Advisory Committee which suggests and evaluates clinical practice recommendations. Serves as a member of the Corporate Compliance Committee. Develops policies and procedures related to care, develops practice guidelines and describes their appropriate use, assures compliance with state and federal regulatory requirements for medical care, participates in the training and education of staff, and reviews and discusses problematic cases with physicians, nurses, nurse care managers and other providers to change and improve treatment plans.
Work with an interdisciplinary team of administrative and clinical staff who are highly experienced in the care of the frail elderly and disabled individuals to develop care plans and guidelines and assess quality.
Must possess a current NYS license and registration;
MD degree from an accredited medical school;
Certification (Internal Medicine a plus); familiarity with Medicare and Medicaid regulatory and reporting requirements.
Experience in a medical/healthcare management capacity
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