Amerigroup in Edison, N.J., is seeking an associate medical director. He or she will work with the chief medical director to oversee medical care for Amerigroup products and services and the membership’s health care needs.
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Responsibilities include planning, organizing and directing the professional medical services program, which consists of all primary and specialty services for inpatient, outpatient, preventive and wellness programs. The position will also design and implement health-plan medical policies, goals and objectives and provide professional leadership and direction to the functions within the Medical Management Department (Utilization/Cost Management and Clinical Quality Management).
In addition, the associate medical director will assist with the development of budgets, staffing plans and medical loss-ratio projections, ensuring the adequate allocation of resources to the medical-management functions. Duties will also include participating in risk management, claim adjudication, pharmacy-utilization management, catastrophic-case review, outreach programs, HEDIS reporting, coordination of site-visit reviews, triage, nutrition-service review, provider orientation, credentialing and profiling.
The ideal candidate will have a master’s degree in public health or an MBA and at least five years of clinical experience in the practice of medicine, two of them in medical and/or health administration. He or she must be licensed in the plan state as a doctor of medicine or a doctor of osteopathy.
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