Offer type: full time
Location: Nevada - Las Vegas
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine.
Location: Must be willing to relocate or reside Las Vegas, NV
Responsible for the day to day medical management operations along with local quality and improvement initiatives for the State Health Plan. Primary duties may include, but are not limited to: Interprets existing policies and develops new policies based on changes in the healthcare or medical arena. Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. Supports the Medical Management staff ensuring timely and consistent responses to members and providers. Identifies and develops opportunities for innovation to increase effectiveness and quality. Serves as a resource and consultant to other areas of the company as needed, serves on company committees and may be required to represent the company to external entities and/or serve on external committees, conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations. Provides guidance for clinical operational aspects of the program and supports the medical management staff ensuring timely and consistent responses to members and providers.
Requires M.D. or D.O.; board certification approved by the American Board of Medical Specialties where applicable to duties being performed; must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, and 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.