General Pediatric Physician - Physicians Only Apply - Perm

Company: Nneka Chinyere Anaebonam
Location: Saint Louis
Posted on: April 17, 2024

Job Description:

A General Pediatric Physician practice is seeking a qualified physician for St. Louis, MO. This and other physician jobs brought to you by ExactMD. Medical Doctors Only Apply.

Medical Director (Part-time) - (Internal
Medicine, Family Practice, Pediatrics or Emergency Medicine)--Position Purpose: Assist the Chief
Medical Director to direct and coordinate the medical management, quality
improvement and credentialing functions for the business unit.----
Provides medical leadership of all for utilization management, cost
containment, and medical quality improvement activities. Performs medical
review activities pertaining to utilization review, quality assurance, and
medical review of complex, controversial, or experimental medical services.
Supports effective implementation of performance improvement initiatives for
capitated providers. ------
Assists Chief Medical Director in planning and establishing goals and
policies to improve quality and cost-effectiveness of care and service for
members. Provides medical expertise in the operation of approved quality
improvement and utilization management programs in accordance with regulatory,
state, corporate, and accreditation requirements. ------
Assists the Chief Medical Director in the functioning of the physician
committees including committee structure, processes, and membership. Oversees
the activities of physician advisors. Utilizes the services of medical and
pharmacy consultants for reviewing complex cases and medical necessity appeals.
Participates in provider network development and new market expansion as
appropriate. Assists in the development and implementation of physician
education with respect to clinical issues and policies.------
Identifies utilization review studies and evaluates adverse trends in
utilization of medical services, unusual provider practice patterns, and
adequacy of benefit/payment components. Identifies clinical quality improvement
studies to assist in reducing unwarranted variation in clinical practice in
order to improve the quality and cost of care. Interfaces with physicians and
other providers in order to facilitate implementation of recommendations to
providers that would improve utilization and health care quality. Reviews
claims involving complex, controversial, or unusual or new services in order to
determine medical necessity and appropriate payment.------ Develops 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. Represents the business unit at appropriate state
committees and other ad hoc committees

Education/Experience: Medical Doctor or Doctor of Osteopathy, board certified
preferable in a primary care specialty (Internal Medicine, Family Practice,
Pediatrics or Emergency Medicine). The candidate must be an actively practicing
physician. Previous experience within a managed care organization is preferred.
Course work in the areas of Health Administration, Health Financing, Insurance,
and/or Personnel Management is preferred. Experience treating or managing care
for a culturally diverse population preferred.



License/Certifications: Board Certification through American Board Medical
Specialties. Current state medical license without restrictions.



Actively practicing physician- will be required to work clinically 1 day per
week (Telemedicine acceptable).--

Keywords: Nneka Chinyere Anaebonam, St. Louis , General Pediatric Physician - Physicians Only Apply - Perm, Other , Saint Louis, Missouri