KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting. KEPRO is seeking resumes for a highly experienced professional
Provides the principal leadership and clinical expertise to operations on all medical aspects relating to the peer review process, utilization review activities, case management, and other activities requiring clinical leadership and consultation. Additional key responsibilities may include assisting and promoting business development and strategic planning activities.
Evaluate, redirect and/or respond to inquiries from physicians, providers and customer. Consult with general and/or specialty practitioners regularly and as necessary as business needs require.
Represent and promote KEPRO at seminars, professional societies, hospital medical staff meetings, and other professional settings as appropriate.
Foster appropriate external relationships with attending physicians/surgeons by response to telephone calls and letters, speaking engagements before physician and provider organizations.
Analyze and remain current on national, state, and local regulations and legislation, which impacts the health care profession.
Review medical information trends, experiences and approaches, and assists in the development of strategic plans for clinical improvements.
Ensures compliance with regulatory and accreditation requirements.
Responsible for oversight of medical content of company publications.
Participate in activities specific to contractual arrangements, i.e. Fair Hearings.
Provide medical expertise with respect to planning and establishing goals and policies to improve medical management.
Provides oversight of physician consultants and advisors. Conducts peer-to-peer physician consultations as requested/required; documents consultations.
Work with medical, nursing and administrative staff to identify matters needing shared attention.
Discuss, inform, and facilitate communication and interaction between staff with customers.
The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.
D. or D.O. with current non-restricted license to practice medicine by the Board of Medical Examiners.
License must be in same state as contractually required.
Board certification in a clinical specialty is required.
Knowledge, Skills, Abilities (KSA)
Strong knowledge in quality assurance and utilization review is required.
Contemporary clinician who understands major trends in healthcare and managed care.
Ability to work effectively with a diversity of personalities. Must be approachable; show respect for others, and a consensus builder.
Systems thinker with strong organizational skills who can pull all the pieces together and deliver on time and within budget.
Adaptable with strong collaborative management style, a creative thinker with high energy and enthusiasm, and a team player who promotes the concepts of people working together.
Able to adapt to frequently changing work parameters.
10+ years of clinical practice preferred.
5 to 7 years of experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs and coaching medical staff on healthcare business and practice issues.
Minimum 2 years as a Medical Director in a managed care company preferred.
Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare programs.
Prior review experience or quality assurance committee responsibility in a hospital setting preferred.
Mental and Physical Requirements
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.
KEPRO offers challenging careers, excellent benefits and opportunities for advancement. For consideration, please submit resume and cover letter with salary requirements. Only those candidates identified for an interview will be contacted. No Phone Calls Please. Visit our website at www.KEPRO.com for more information on the KEPRO Family of Companies.
EOE AA M/F/Vet/Disability
KEPRO is an E-Verify employer. E-Verify is an internet based system operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA) that allows participating employers to electronically verify the employment eligibility of their newly hired employees in the United States.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.