Medical Director
Virgin Islands Social Security Board
Localização do trabalho
Road Town
Status de emprego
Tempo total
Detalhes sobre a oferta de trabalho
Job Summary
This position is responsible for providing medical oversight and medical necessity of health care services provided to beneficiaries, targeting improvements in efficiency, quality, and satisfaction for patients and providers aimed to enhance and achieve the overall goals of NHI.
Essential Functions
· Assists in the medical aspects of the NHI Emergency Overseas Treatment Program.
· Documents clinical review findings, actions, and outcomes in accordance with RHSO policies, regulatory, and approved requirements.
· Provides medical leadership across NHI departments as needed
· Chair the Quality Improvement Committee
· Chair the Credentialing Committee
· Chair the Pharmacy and Therapeutics Committee
· Review all appealed claims denials
· Overturn/uphold pre-service and retrospective medical necessity appeals
· Approve/deny preauthorization request that do not meet medical necessity criteria per UM nurse review
· Provide support to the Clinical team for complicated cases as needed.
· Provide support to the pharmacy staff Review performance and utilization reports
· Prepare and present data to NHI staff, the NHI governing body and the public
· Direct specific aspects of the medical management program including Quality Improvement, Pharmacy, Disease Management and Wellness Initiatives
· Review performance and utilization reports
· Collaborate with Mgr. Referrals & Health Services for medical evacuations.
· Provides support to the clinical management staff as needed.
· Prepares and presents data to NHI staff, NHI governing body, and the public.
· Member of the Auditing of Providers Team.
Performs other duties or special projects as required or as assigned
