Medical Director I

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Best People, Best Solutions, Best Results

Job Summary:

Responsible for assuring the clinical integrity of the organization, our products, and our services with particular focus on our contract(s) in multiple jurisdictions, including federal and state. Provides administrative and clinical support to assigned project teams.

Essential Duties and Responsibilities include the following. Other duties may be assigned

Medical Review Oversight may include:

• Physician peer review activities
• Criteria development and assessment
• Correspondence regarding review determination
• Recruitment, credentialing, and training of expert physician reviewers
• Managing the expert physician advisory network in specific geographic areas
• Serving on external committees

Professional Relations may include:

• Interfacing with external organizations including physician specialty groups, hospital associations, medical societies, affiliates contractors, and state and federal agencies
• Discussing specific clinical issues with attending physicians

Health Care Quality Improvement/Assurance may include:

• Leading and/or participates in quality improvement projects as needed
• Providing clinical input to specific projects as required by the organization or contractors
• Supporting project managers or teams with specific collaborative projects as needed
• Maintaining working knowledge of current quality improvement issues and tools

To perform the job successfully, an individual should demonstrate the following competencies:

• Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses experience to complement data.
• Quality Management - Looks for ways to improve and promote quality.
• Business Acumen - Understands business implications of decisions; Demonstrates knowledge of market and competition; Aligns work with strategic goals; Contributes to the development of responses to Requests for Proposals.
• Communication - Utilizes established protocols to communicate in an effective and timely manner with coach, project staff, and contract members.
• Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
• Design - Generates creative solutions; Translates concepts and information into images; Uses feedback to modify designs; Applies design principles; Demonstrates attention to detail.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Planning/Organizing - Prioritizes and plans work activities; Sets goals and objectives; Completes work within required contractual timelines.
• Organizational Support - Supports organization's goals and values; Benefits organization through outside activities.

Education and/or Experience:

• Doctoral degree (MD) with at least 5 years clinical experience or at least 5 years in an administrative position in health care, with a focus of quality improvement or quality assurance.
• Advance degree in public health or health care administration preferred. May consider an equivalent combination of education and experience.
• Depending on contract requirements may also require additional experience; experience with Medicare and/or Medicaid; and/or board certification.

Other Skills and Abilities:

• Uses knowledge and experience to interpret medical polices and guidelines. Complies with specific contract requirements.
• To perform this job successfully, an individual should have knowledge of Word Processing software.
• Must have basic understanding of the use of the computer.

Certificates, Licenses, Registrations:

• Valid, current, active, and unrestricted clinical physician license and practice as a health professional in a state or territory of the United States.

Travel Requirements:

• Travel requirements vary based on contract requirements may require periodic overnight and/or local travel. Must be willing to travel in accordance with company and contract needs.

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.