Accenture is a global professional services company with leading capabilities in digital, cloud and security. Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Interactive, Technology and Operations services-all powered by the world's largest network of Advanced Technology and Intelligent Operations centers. Our 537,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities. Visit us at www.accenture.com .
In today's business environment, growth isn't just about building value-it's fundamental to long-term business survival. So how do organizations sustain themselves? The key is a new operating model-one that's anchored around the customer and propelled by intelligence to deliver exceptional experiences across the enterprise at speed and at scale. You will deliver breakthrough business outcomes for clients-by harnessing talent, data and intelligence to revolutionize their operating models.
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Operations is one of four services that make up one Accenture -the others are Strategy and Consulting, Interactive and Technology.
The Medical Director is an integral member of the leadership team. They will utilize their medical expertise and knowledge of health care delivery systems, utilization reimbursement methods, and treatment protocols to provide daily guidance, support and medical leadership for all aspects of the utilization management activities. The ideal candidate will be a lead in medical review quality improvement and review process optimization. They will be a key clinical contact for external clients and regulatory agencies, in addition to a key advisor for the internal sales teams.
Key Responsibilities
- Oversee key quality metrics for services provided internally and to external clients, including cost of care and satisfaction metrics
- Oversees utilization management and performs utilization reviews and performs denials
- Guides staff in the interpretation of medical policy
- Provides day to day clinical guidance, support and leadership for utilization management activities and decisions
- Partners with external clients, governing bodies, entities, vendors and programs to increase effectiveness of medical management programs
- Advises nurses and leaders in clinical decision-making activities including prior authorization, concurrent and retrospective review and medical necessity decisions, case management and disease management decisions
- Conducts analysis of medical management data to identify opportunities for intervention and improvement, assists in the design and implementation of corrective action plans to address issues and improve plan and network managed care performance of key quality metrics for services provided to external clients, including cost of care, quality, and satisfaction metrics
- Oversees clinical requirements policies for Utilization Review Accreditation Commission (URAC) or National Committee for Quality Assurance (NCQA) accreditation, and support accreditation activities, as needed
- Responds to accrediting and regulatory agencies
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Qualifications
Basic Qualifications
- Doctor of Medicine, MD or Doctor of Osteopathic Medicine, DO
- Active or working towards Texas license to practice medicine without restriction, issued by the State Board of Licensure or the State Board of Osteopathic Examiners
- Minimum 3 years of clinical experience
- Medical management health administration experience in a managed care environment
- Medicaid experience
- Board certification in an area of specialty
- Management of staff including performance management
- Knowledge in the procedures of utilization management
- Ability to interpret apply medical policy and policies
- Broad clinical knowledge and understanding of current health care issues
- Demonstrated ability to serve as a clinical subject matter expert (SME) during meetings with prospective clients or industry leaders
- Able to work in medical management systems
- Master's in Public Health, MBA or MA Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management.
- Strong strategic thinking ability and business acumen
- Demonstrated client relationship building skills
- Flexibility to travel domestically and internationally, as required
- Must be comfortable working in a matrix managed global organization
- Skills or experience in reorganization and turnaround
- Skills or experience with process improvement
- Experience creating and articulating the client value proposition of a service is highly desirable
- Demonstrated leadership, teamwork and collaboration in professional setting either military or civilian
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