Internal Medicine Physician General Internist - Physicians Only Apply - Perm
Company: Necnic Group, LLC
Location: Los Angeles
Posted on: July 1, 2020
A Internal Medicine Physician General Internist practice is
seeking a qualified physician for Los Angeles, CA. This and other
physician jobs brought to you by ExactMD. Medical Doctors Only
Senior Medical Director (Internal Medicine, Family Practice,
OB/GYN, Pediatrics or Emergency Medicine)
Position Purpose: Assist the Chief Medical Officer (CMO) to direct
and coordinate the medical affairs functions for the business unit.
Oversee the denials and appeals department. May manage other
----- Provide medical leadership for all utilization management,
pharmacy, case management, disease management, cost containment,
and medical quality improvement activities. Perform medical review
activities pertaining to utilization review, quality assurance, and
medical review of complex, controversial, or experimental medical
services. Support the effective implementation of performance
improvement initiatives for capitated providers.
----- Assist CMO in planning and establishing goals and policies to
improve quality and cost-effectiveness of care and service for
members. Provide medical expertise in the operation of approved
quality improvement and utilization management programs in
accordance with regulatory, state, corporate, and accreditation
----- Assist the CMO in the functioning of the physician committees
including committee structure, processes, and membership. Oversee
the activities of physician advisors and other medical directors.
Utilize the services of medical and pharmacy consultants for
reviewing complex cases and medical necessity appeals. Participate
in provider network development and new market expansion as
appropriate. Participate in provider profiling initiatives. Assist
in the development and implementation of physician education with
respect to clinical issues and policies.
----- Identify utilization review studies and evaluates adverse
trends in utilization of medical services, unusual provider
practice patterns, and adequacy of benefit/payment components.
Identify clinical quality improvement studies to assist in reducing
unwarranted variation in clinical practice by profiling providers
in order to improve the quality and cost of care. Interface with
physicians and other providers in order to facilitate
implementation of recommendations to providers that would improve
utilization and health care quality. Review claims involving
complex, controversial, or unusual or new services in order to
determine medical necessity and appropriate payment.
----- Develop alliances with the provider community through the
development and implementation of the medical management programs.
As needed, may represent the business unit before various publics
both locally and nationally on medical philosophy, policies, and
related issues. Represent the business unit at appropriate state
committees and other ad hoc committees.
----- Oversee all aspects of the Appeals and Denials department
including implementing budgetary, policy, and personnel decisions
for the department.
Education/Experience: Medical Doctor or Doctor of Osteopathy, board
certified in a primary care specialty (Internal Medicine, Family
Practice, OB/GYN, Pediatrics or Emergency Medicine). Course work in
the areas of Health Administration, Health Financing, Insurance,
and/or Personnel Management is preferred. Previous management
experience including responsibilities for hiring, training,
assigning work and managing performance of staff. Previous
experience within a managed care organization and with Medicaid
programs is preferred. Experience treating or managing care for a
culturally diverse population preferred.-- Medical management
License/Certification: Board Certification through American Board
California licensed physician and actively practicing physician
Board certification.-- Willing to work in Woodland Hills or Oakland
office (4 days a week with 1 clinical practice day).
Keywords: Necnic Group, LLC, Los Angeles , Internal Medicine Physician General Internist - Physicians Only Apply - Perm, Healthcare , Los Angeles, California
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