Sr Medical Director, Medical Management

Are you a physician leader with experience working in a managed care setting? Are you ready to revolutionize healthcare and make a lasting impact on the well-being of communities? We are seeking an experienced Senior Medical Director to lead Medical Management.

As the Senior Medical Director specializing in Medical Management, you will oversee a team of Associate Medical Directors, responsible for second level medical necessity reviews, offering expert medical opinion and guidance on complex cases. You will also oversee the Medical Policy development team where your clinical and managed care experience will play a key role in helping our members achieve the quadruple aim.

Benefits:

• Unique, provider-sponsored model, enabling care and outcomes that are more integrated, less duplicative, and more lasting; with the added advantage of being aligned to some of the top hospitals and healthcare systems in the country.
• Latitude and encouragement to think differently and leave a legacy of innovation through leading the delivery of solutions and care models that will improve the lives of Quartz members and the overall healthcare delivery system.
• Competitive compensation and benefits package, with the flexibility to work remotely as needed

• Conduct medical necessity reviews and determinations of prior authorizations and referrals, including reviews of previously denied and appealed decisions
• Oversight and day-to-day management of a team of Associate Medical Directors, and the Medical Policy Development team including performance management, timekeeping, and managing the MD calendar to ensure adequate coverage during business hours and ad hoc
• Oversight of Medical Policy development
• Provide clinical strategy and physician input to various Clinical Services departments, including: Utilization Management, Care Management, Medical Policy, Behavioral Health, Population Health, Quality, and Clinical Informatics

• MD or DO with current and ongoing Board Certification in an ABMS Medical Specialty
• Unrestricted current medical license in the state of Wisconsin and other states as necessary.
• 12+ years of direct clinical patient care experience post residency or fellowship, with at least 3 years working in managed care setting.
• Knowledge of medical management principles, including utilization management, prior authorization, case management, concurrent and retrospective review – including experience working with national guidelines such as MCG and InterQual
• Familiarity with the National Committee for Quality Assurance (NCQA) Health Effectiveness Data and Information Set (HEDIS) principles, accrediting requirements, and CMS Star ratings for Medicare lines of business
• Ability to plan, organize, execute assignments to meet deadlines
• Ability to communicate in a manner that builds constructive, effective relationships with colleagues across many functions, providers, and members

Quartz offers an excellent benefit and compensation package, opportunity for career advancement and a professional culture built upon the foundations of Respect, Responsibility, Resourcefulness, and Relationships. All employment offers are contingent upon successful completion of a pre-employment criminal background check and license & credential verification.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.