Head - Medical Affairs

JOB DESCRIPTION:

• Participates in strategy development meetings. Work with the Chief Medical Officer (CMO) and Deputy CMO in developing and implementing innovative procedures, regulations, and programs to improve efficiency, quality, and customer service of the Medical and Provider Services Division.
• Acts as co-lead in dealing with provider groups for all medical practice matters. Developing the best possible working relationships between iCare and its Accredited Providers (Doctors/Hospitals/Clinics/Wellness Partners).
• Ensures provider network meets strategic goals of managing utilization cost while providing high quality healthcare to members of iCare.
• Initiate, coordinate, attend meetings that relate to Provider credentialing and iCare’s compliance with regulatory requirements, etc.
• Oversee the clinic management business/portfolio of iCare and ensure coordination with the company clinics on utilization management initiatives and appropriate care implementation.
• Provides when needed medical guidance and interpretation for all utilization management issues (Prior Authorization, Concurrent Review, Retrospective Review)
• Guide the MSC and HLO team with the Pre-approval and concurrent review of cases for proper administration of benefits and appropriate care.
• Provide medical guidance in Claims adjudication as necessary.
• Conduct Utilization Review with specific accounts.
• Evaluation of appropriateness of medical care services utilized by the account members.
• Address short term and long-term issues by providing information and medical recommendations pertinent to deliberations, presenting options, and recommending courses of action.
• May function as the Lead Healthcare Professional to cover services including but not limited to answering medical/clinical inquiries both internal and external.
• Co-manage the Medical Provider and Services Division, which may include but is not limited to interviewing and selection, goal setting, and coaching of staff.
• Participate and lead in appropriate healthcare programs for clients as necessary.
• Creation of preventive health programs in the corporate setting based on the profile of the clients.
• Oversee the implementation and management of the Chronic Disease Management Program, Sleep Better Program and other health and wellness initiatives of iCare.

JOB QUALIFICATIONS:

• Licensed Medical Doctor
• Preferably with HMO/insurance experience
• Preferably with Certification on Occupational Health and Safety
• With above average knowledge on Microsoft Office (excel, word, powerpoint, outlook)

Job Type: Full-time

Schedule:

• 8 hour shift

Application Question(s):

• How much is your expected salary?