Regional Medical Director Resume Samples

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ED
E Daniel
Evangeline
Daniel
13418 Heath Course
Los Angeles
CA
+1 (555) 976 2734
13418 Heath Course
Los Angeles
CA
Phone
p +1 (555) 976 2734
Experience Experience
01/2014 present
Phoenix, AZ
Medical Affairs & Regional Medical Director
Phoenix, AZ
Medical Affairs & Regional Medical Director
01/2014 present
Phoenix, AZ
Medical Affairs & Regional Medical Director
01/2014 present
  • Highly motivated team created through leadership, coaching, training and people development
  • All MA staff are fully trained in line with expectations of their role and compliant with any issues identified during audits or inspections resolved
  • Approval of local study commitments, budgets and investigator site selection as determined by operational feasibility assessments
  • Establishes effective interaction between USMA and other Roche/Genentech functions; and with the region and global Development and Medical Affairs functions
  • Integration of Life Cycle Team, Global Medical Affairs and US priorities for medical affairs clinical studies
  • Ensures all Company Quality, Compliance and Safety Directives are implemented including effective implementation of the North American Quality Management System (QMS)
  • Contribute to approval of promotional activity and materials through ensuring medical input into the promotional review process led by US Regulatory Affairs and issues resolution via membership of the Promotional Review Oversight Committee
05/2010 07/2013
Philadelphia, PA
Associate Regional Medical Director
Philadelphia, PA
Associate Regional Medical Director
05/2010 07/2013
Philadelphia, PA
Associate Regional Medical Director
05/2010 07/2013
  • Creates team environment and maximizes team effectiveness by collaborating with physician staff, non-physician practitioners and nursing personnel
  • Sets and maintains clinical standards in the region by driving decisions that are patient-centered, collaborative, evidence based, and focused on both quality and utilization
  • Builds and maintains strong relationships with site medical providers by visiting all sites they are responsible for, in person
  • Proactively informs client of risks and high profile patient management cases and how both are being managed
  • Provides clinical leadership for statewide care management: monitors site results through data review and care management calls which decrease negative variances and promote the sharing of best practices
  • Identifies opportunities for enhancements and works with regional team to design and implement changes to improve efficiency in clinical operations and workflow
  • Represents the company and correctional medicine at medical osteopathic residency programs, conferences,and other venues in order to create awareness about correctional medicine and Corizon
03/2006 11/2009
San Francisco, CA
Regional Medical Director
San Francisco, CA
Regional Medical Director
03/2006 11/2009
San Francisco, CA
Regional Medical Director
03/2006 11/2009
  • Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTACH, Acute rehab, SNF) according to the Humana Medicare Model of Care (MMOC) in all cases where Humana retains some or all of Part A risk in the contractual relationship with IPA’s/MG’s. Also use MMOC to manage HMO & POS members who utilize their out-of-network benefits
  • Design, develop, and implement educational events to build product awareness and advocacy and to support and facilitate medical communications and publications (e.g. abstracts, case studies/series, review articles, etc.)
  • Organize clinical advisory boards and other scientific meetings with academic investigators, explore potential new indications, and procure input on the overall clinical development plan at the request of Clinical and Medical Affairs
  • Working in conjunction with the medical affairs and clinical development teams, evaluate potential external clinical research collaboration opportunities and facilitate the conduct of all external clinical investigator-sponsored trials (ISTs) and phase 4 trials
  • Monitor the competitive environment for advances and trends in our therapeutic areas, including new treatment management and new therapies, as well as competitive products and features and provide feedback to the senior leadership team on specific initiatives of competitors
  • Confers with regional team daily to stay apprised of critical situations, collaborate on action steps and/or treatment plan, paying attention to trends and opportunities for improvement
  • Provides clinical leadership for statewide care management: monitors site results through data review and care management calls which decrease negative variances and promotes the sharing of best practices
Education Education
Bachelor’s Degree in Health Sciences Required
Bachelor’s Degree in Health Sciences Required
University of North Texas
Bachelor’s Degree in Health Sciences Required
Skills Skills
  • Exceptional oral and written communication and interpersonal skills (including strong demonstration of ability to network)
  • Strong interpersonal skills and relevant experience in building professional relationships and networking
  • Demonstrated decision making: ability to problem solve and develop and apply creative solutions and implement those decisions effectively
  • Development of regional and sub-regional strategies, and a plan to achieve designated utilization and quality goals/targets
  • Knowledge and understanding of managed care distribution channel
  • Knowledge and understanding of clinical and regulatory guidelines
  • Knowledge and understanding of compliance in commercial settings
  • Knowledge and understanding of
  • Demonstrated excellent project management skills and follow through
  • Demonstrated ability, or potential, to excel in smaller entrepreneurial organizations
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1

Puerto Rico Regional Medical Director Resume Examples & Samples

  • Active, unrestricted PR license
  • Medicare/Commercial Knowledge
  • Excellent presentation and analytical skills
  • Exceptional written and oral communication skills to a wide range of associates (front-line to leaders) and both internal and external audiences in English and Spanish
2

Mid Atlantic Regional Medical Director Resume Examples & Samples

  • Medicare/Medicaid Knowledge
  • Exceptional written and oral communication skills to a wide range of associates (front-line to leaders) and both internal and external audiences
  • Ability to rapidly build positive relationships with consumers, employers, and providers at all levels in the marketplace
  • Ability to thrive in a highly matrix environment
3

Gulf States Regional Medical Director Resume Examples & Samples

  • Provides clinical leadership to enhance medical management strategies and interventions designed to produce optimal quality outcomes with efficient use of clinical resources
  • Play an active role in the regional medical community. Serve as the primary interface with the regional provider community to educate providers, strengthen provider relations and improve provider clinical service and cost performance
  • Ensure participation on market committees that require medical expertise
  • Provide medical input and clinical expertise for regional medicare utilization management, quality management and pharmacy activities. Provide support and ensures compliance with all regulatory issues related to utilization management
  • Implement quality improvement programs as defined by corporate leadership and CMS
  • Responsible for medical interpretation, reviews, and decisions as required for plan administration
  • MD/DO Board Certified in a Medical Specialty
  • Active MD license in the state(s) in which you are required to practice
  • Advanced experience working in a private medical practice or in a hospital setting
  • Board Certification in Family Practice or Internal Medicine
4

Northeast Regional Medical Director Resume Examples & Samples

  • Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana Medicare Model of Care
  • Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs
  • Assist with network development and provider contracting with various providers and ancillary providers
  • Well-versed on financial aspects of various levels of risk bearing contracts and possess the ability to gain traction and adoption of the providers
  • MD/DO Board Certified in an ABMS Medical Specialty
  • Active unrestricted medical license
  • Supervisory skills including clinical mentoring and coaching
5

Regional Medical Director Resume Examples & Samples

  • Advanced Clinical/Science degree or professional credentials required (MD, PhD or PharmD)
  • Minimum of 3 years post professional degree practice or relevant transferable experience (clinical practice, clinical or scientific training, academic research, and regulatory/scientific)
  • Minimum 1 year experience in a Medical Affairs organization
  • Experience in Medical/Cosmetic Dermatology, Plastic Surgery, Cellular Biology, and/or Facial Aesthetic disciplines strongly desired
  • Ability to think creatively and conceptually
  • Ability to develop and execute key strategies
  • Strong analytical skills and presentation skills
  • Strong problem resolution skills
  • Experience performing research and/or analyzing clinical research data
  • Proven ability to develop relationships with physicians and other Healthcare Professionals
  • Proven ability to work effectively in a cross-functional environment
  • Ability to support 70% travel schedule
6

Regional Medical Director Resume Examples & Samples

  • Network and partner with important external customers, including medical thought leaders, academic institutions, large group practices, medical directors, managed care decision makers, and pharmacy directors is required. Must prioritize and work effectively in a self-directed manner in a constantly changing environment. Must be able to gain, integrate, and communicate customer feedback so that effective solutions can be arrived at quickly
  • Pairing customers’ unmet needs with available internal resources will be a key success factor for this position. The RMD must be a strong team player who can effectively interface cross-functionally within Horizon
  • Knowledge of and responsibility for collaboration within all functional areas across the Company is required
  • Must demonstrate a working knowledge of health and pharmacoeconomic outcomes research, Medical Information, Research Grant Processes, Continuing Education, and Regulatory/Compliance issues as they relate to the effective dissemination of scientific information
  • Collaborate with Managed Markets team, to identify opportunities and needs that can be addressed via communication of scientific, medical, and health economic information
  • Add value to Horizon-sponsored external speaker programs via identification of potential new speakers and training on scientific content
  • Design, develop, and implement educational events to build product awareness and advocacy and to support and facilitate medical communications and publications (e.g. abstracts, case studies/series, review articles, etc.)
  • Organize clinical advisory boards and other scientific meetings with academic investigators, explore potential new indications, and procure input on the overall clinical development plan at the request of Clinical and Medical Affairs
  • Participate in international, national, and regional conferences, meetings, and other scientific venues as appropriate with Horizon Medical/Clinical strategy
  • Working in conjunction with the medical affairs and clinical development teams, evaluate potential external clinical research collaboration opportunities and facilitate the conduct of all external clinical investigator-sponsored trials (ISTs) and phase 4 trials
  • Monitor the competitive environment for advances and trends in our therapeutic areas, including new treatment management and new therapies, as well as competitive products and features and provide feedback to the senior leadership team on specific initiatives of competitors
  • Assure appropriate deployment of field resources and that they are compliant with Horizon legal and all applicable regulatory guidelines to ensure medical and scientific accuracy and fair balance
  • Advanced degree in Health Sciences required (MD, PhD, or Pharm D preferred)
  • Minimum of 3-5 years clinical and experience with a strong current working knowledge of the healthcare and pharmaceutical environment is required. Rheum knowledge and experience preferred
  • At least 5 years previous pharmaceutical industry experience as an MSL or other Medical/Clinical Affairs role is required
  • Knowledge of treatment guidelines, clinical research processes, FDA regulations, OIG guidelines and research or clinical experience in the management of orphan/rare disease products is desired
  • Demonstrated ability, or potential, to excel in smaller entrepreneurial organizations
  • Exceptional oral and written communication and interpersonal skills (including strong demonstration of ability to network)
  • Ability to understand, integrate and effectively communicate scientific/medical and commercial value of Horizon’s products to the medical community and other key internal and external audiences
  • Knowledge and understanding of managed care distribution channel
  • Knowledge and understanding of clinical and regulatory guidelines
  • Knowledge and understanding of compliance in commercial settings
  • Ability to travel up to 60% for territory management, attend regional and international conferences/workshops to obtain new competitive information, keep abreast of clinical trends, and support and maintain relationships with key investigators and scientific research
  • Ability to respond appropriately to needs of key stakeholders and manage expectations
  • Demonstrated excellent project management skills and follow through
  • Must have excellent PC skills and be familiar with current clinical software and database tools
7

Regional Medical Director, Americas Resume Examples & Samples

  • As the vaccines business grows, the individual is able to adapt the regional structure over time and successfully manage a shift in priorities and focus. Is moreover able to seize regional growth opportunities to further develop the capabilities of the vaccine business unit
  • As appropriate, hires, manages, mentors, motivates, empowers, develops and retains staff to support assigned activities
  • Previous experience successfully leading a clinical development team/matrix team with responsibility for studies/activities in multiple regions
  • Experience and demonstrated ability to lead and manage highly trained medical, scientific and technical professionals preferred
  • Vaccines, immunology, infectious diseases, public health
  • Regional/country medical and regulatory requirements and practices
8

Regional Medical Director Resume Examples & Samples

  • Interact directly with specific divisions based on pertinent clinical and development expertise to provide knowledge/understanding of regional market environment in line with status of the scientific content matter expert for assigned products
  • Is an advocate of Takeda’s values internally and externally
  • Medical Degree or internationally recognized equivalent with the relevant industry experience and 5 years of clinical research experience within the Vaccines industry or CRO health-related consulting company, or biomedical/clinical experience within academia (or a combination of afore mentioned)
  • Ability to proactively predict issues and solve problem
  • Emerging research in designated therapeutic area
9

Regional Medical Director, Namm Resume Examples & Samples

  • Works primarily with the physician community around issues of particular patients, balancing business and clinical concerns
  • Provides limited utilization management for outpatient medical, surgical and pharmacy activity
  • Participates in medical appeals activity. Reviews all 2nd-level overturned cases related to medical necessity / investigational issues in the context of potential medical policy updates
  • Works with the Appeals area on appeals related to utilization management issues
  • Provides medical leadership and physician advice to the quality management area with respect to quality improvement studies, quality improvement committees, primary care assessments (both office-site assessments and medical record document reviews)
  • Performs peer reviews on quality complaints, sentinel events, and quality-of-care referrals
  • Serves as Physician Advisor for other areas within the company, including but not limited to Sales and Marketing, Underwriting, PHP, and Provider Services
  • Provides medical leadership and advice for conformance with standards and guidelines for NCQA, URAC, state and federal regulators, and other accrediting bodies
  • Acts as liaison for communication with physicians, hospitals, and other providers in the community
  • Reviews customer service and claims inquiries
  • Possess a current and unrestricted MD or DO license in California
  • 5+ years of clinical practice in direct patient care
  • 5+ years of medical management or administrative experience in a managed care setting
  • Possess sufficient clinical knowledge to interact with the physician members of the IPA in all major medical specialties
  • Board certification in their chosen specialty
  • Board Certified in Geriatrics
  • Prior experience working with clinical information technology systems
10

Regional Medical Director Resume Examples & Samples

  • Performance and development
  • Manage the performance and development of team members utilizing the Lilly coaching model
  • Monitor, evaluate, and hold team members accountable to all performance expectations
  • Develop personnel through scheduled interactions, including field visits
  • Recruit and staff field-based positions and take full responsibility for these personnel decisions; ensure standards of qualifications for MLs are maintained
  • Manage and optimize personnel resources across the geography
  • Contribute to succession planning and talent development discussions
  • Oversee quality, compliance, accountability, and effectiveness of field operations
  • Partner with the Oncology Business Unit, the Medicines Development Unit, and US ML Strategy and Capabilities Team to drive operational efficiency, consistency, and compliance
  • Analyze retrospective data on customer facing activities and internal focused project work balance, and review all Voice of the Customer survey results. Analyze these data to provide appropriate coaching to identify opportunities to improve the performance of Medical Liaisons
  • Monitor and manage team travel budget, team building and team meeting expenses, and individual expense reports
  • Plan, lead, and implement motivational, scientific, and operationally robust meetings with Medical Liaison teams
  • Conduct business reviews with US ML Strategy and Capabilities and oversee field-based compliance, documentation, auditing, and corrective action for all ML activities and procedures as defined by the MQS Global Standard and Procedure
  • Identify and establish relationships with strategic research partners, including physicians, scientists, and sites, based on volume and priority of ongoing medical collaborations with Lilly
  • Communicate and influencestrategic placement of clinical trial sites. Provide oversight of scientific support and collaboration to enable smooth execution of clinical trials in key institutions
  • Identify, develop, and overssee implementation of scientific initiatives to support the strategy and regional customer and business needs
  • Serve as the primary Medical point person liaising between the regional health systems and Lilly business partners and drive communication updates impacting relationships within an institution or health system with the Regional Senior Business Director as well as the US Health Outcomes Director
  • Developing and maintain ongoing partnerships with Lilly personnel on the business side to remain knowledgeable of the challenges facing the health system outside of medically oriented concerns
  • Maintain a broad understanding of the regional commercial business and ensure, where appropriate, the right resources are coordinated towards driving an exceptional customer experience
  • Ensure appropriate resources and capabilities are in place and prepared to execute institutional and HCP medical launch readiness activities and life cycle needs of commercially approved assets as well as compounds in development
  • Support medical affairs staffing and delivery of insights from congresses and clinical insights and ensure insights are integrated into the regional medical strategy
  • Develop the medical regional business plan and participate in the higher level business planning process to ensure the medical resource planning is aligned with regional and business unit objectives
  • Provide oversight of development and strategic alliance management
  • Maintain broad medical knowledge across diseases, established treatments, and treatments under investigation in our research portfolio to effectively respond to inquiries
  • Engage in continuous learning about the healthcare system, the external environment, (healthcare reform, quality initiatives, payer initiatives with integrated health systems), and the internal Lilly environment and functions
  • Partner with Lilly business partners and health system staff, as requested and appropriate, to establish him/herself as a reliable, trusted partner providing accurate information and available medical resources with the health system
  • Respond in a timely manner to personal or electronic inquiries with information pertinent to the request, which may include information obtained from other Lilly personnel
  • Advanced degree in health sciences (PharmD, M.D., Ph.D. in a medically related field) required with 2-3 years of relevant clinical or therapeutic area experience desired. Masters or Bachelors level degree in health sciences (RN, RPh, PA, Certified Diabetes Educator, NP, etc.) considered if 5 or more years clinical and/or medical information experience in relevant therapeutic area is present
  • Three or more years experience in pharmaceutical industry required
  • Strong clinical background specific to oncology preferred
  • Familiarity/experience with regulated environments is required
  • Clinical Trial and/or drug development experience is preferred
  • Experience in field-based environments strongly recommended
  • Strong interpersonal skills and relevant experience in building professional relationships and networking
  • Significant experience in motivating people, creating positive team experiences, and coaching/developing technical personnel highly recommended
  • Demonstrated leadership and the ability to achieve results through people
  • Demonstrated learning agility for acquiring technical knowledge; able to provide effective feedback on the quality of verbal and written technical communications and documentation by personnel, and provide direction to technical coaches and team
  • Demonstrated decision making: ability to problem solve and develop and apply creative solutions and implement those decisions effectively
11

Regional Medical Director Resume Examples & Samples

  • Serve and fulfill all expectations as medical director for one or more GPS centers
  • Provide direct patient care for unassigned patients, sharing on-call responsibilities, at one or more GPS centers
  • Provide interim direct patient care and/or medical director services at other centers within the region as needed to resolve unexpected circumstances
  • Actively participate in the Genesis HealthCare ACO
12

Vaccines Regional Medical Director Resume Examples & Samples

  • Minimum 4 years clinical experience in the United States
  • Breadth of knowledge in clinical medicine and public health
  • Ability to interpret complex technical data to match communication needs of recipients
  • Understanding of the evolving healthcare market and managed-care/payer environment
  • Understanding of quality management and performance improvement in clinical medicine
  • Strong knowledge and understanding of legal and regulatory environment and Merck’s policies
13

Regional Medical Director Resume Examples & Samples

  • Develop and maintain peer-to-peer collaborations and relationships with key medical experts and researchers in the region
  • Understand and champion local initiatives on disease and treatment guidelines. Prior demonstration and ability of collaboration with commercial and sales on a regular basis to ensure proper collaboration and planning according to company compliance guidelines
  • Advanced scientific or clinical degree (MD, PhD, or Pharm D) required
  • Minimum of 3-5 years clinical experience with a strong current working knowledge of the healthcare and pharmaceutical environment is required. Therapeutic area knowledge and experience preferred
  • Knowledge of treatment guidelines, clinical research processes, FDA regulations, OIG guidelines and research or clinical experience in the management of pain and/or rheumatic disease is desired
  • Ability to travel up to 70% for territory management, attend regional and international conferences/workshops to obtain new competitive information, keep abreast of clinical trends, and support and maintain relationships with key investigators and scientific research
  • French (written and spoken) is a plus
  • Due to time zone differences, may be required to participate in teleconferences early mornings or late evenings
  • Office is home-based. General travel guidance within assigned geography: 3-4 days per week (with 1-2 office days per week). Required travel to medical conventions, department meetings and other group meetings (will require some weekends)
14

Regional Medical Director Resume Examples & Samples

  • BC MD/DO with an active unrestricted Missouri license
  • Knowledge of Medicaid and Medicare programs, specifically Medicare Advantage
  • Strong knowledge of MA coding and documentation policies and procedures in a value based relationship
  • Licenses in Missouri
15

Medical Affairs & Regional Medical Director Resume Examples & Samples

  • As Chairman of the Medical Leadership Team (MLT) providesstrategic direction, leadership and management to USMA which consists of therapeutic area (Oncology, Immunology/Infectious Diseases, New Therapeutic Areas and Established Brands) and functional (safety, evidence generation, knowledge enhancement and strategy/portfolio management) medical units
  • Contributes to the leadership and management of Genentech through active participation in the Affiliate Pharma Executive Team
  • Ensures the Company adheres to the highest scientific and ethical standards, fulfils all safety reporting obligations and is held in high regard by patients, customers, investigators and other stakeholders in both the US and Canada
  • Establishes effective interaction between USMA and other Roche/Genentech functions; and with the region and global Development and Medical Affairs functions
  • Integration of Life Cycle Team, Global Medical Affairs and US priorities for medical affairs clinical studies
  • Ensures all Company Quality, Compliance and Safety Directives are implemented including effective implementation of the North American Quality Management System (QMS)
  • Represents Genentech on external committees as required
16

Regional Medical Director Resume Examples & Samples

  • Provides clinical leadership for statewide care management: monitors site results through data review and care management calls which decrease negative variances and promotes the sharing of best practices
  • Conducts medical leadership meetings to educate team and oversee clinical quality processes. at least quarterly
  • Oversees quality of care delivered by off-site and on-site specialists within the region
  • Interprets trends and takes action at the regional level for improving health status of the population, partnering with the client to implement appropriate interventions
  • Develops and leads a team of physicians in UM decision making, compliance with clinical quality and UM programs specific to contract requirements, and adherence to corporate UM and clinical quality policies and procedures
  • Identifies opportunities for enhancements and works with regional team to design and implement changes to improve efficiency in clinical operations and work flow
  • Mentors, monitors, and utilizes regional staff in the appropriate use of medications (formulary, and non formulary) and in medication administration (e.g. side effect profile, adherence, drug/drug interactions)
  • Collaborates with VPO (Vice President of Operations), Regional Manager (RM) and other site operational leaders to identify, interview, select, and retain Site Medical Directors and site physicians. Knows and ensures compliance with credentialing requirements for all providers, independent contractors and physician assistants across area of responsibility
  • Confirms Physician Information Programs (PIPs) are completed timely and accurately for all new providers either personally and/or with Associate Regional Medical Director (ARMD)
  • On-boards, supervises and mentors Site Medical Directors and ARMDs in UM and QI tools, techniques and processes within the corrections environment
  • Role models and develops strong leadership and management skills in Site Medical Directors and ARMDs
  • Mentors Regional Director of Nursing (RDON) by sharing clinical and administrative objectives and collaborating on planning for and taking action to achieve stated goals
  • Mentors PLP (Physician Leadership Program) participants for the purpose of preparing them for the next level of responsibility
  • Confers with regional team daily to stay apprised of critical situations, collaborate on action steps and/or treatment plan, paying attention to trends and opportunities for improvement
  • Conducts thorough and timely Peer Reviews for Medical Directors and non-physician practitioners, according to Corizon Health policy and procedures
  • Identifies candidates with leadership potential from among site physicians/site medical directors, creates development plans and mentors these high potentials
  • Represents Corizon Health and correctional medicine at medical and osteopathic residency programs, conferences, and other venues in order to create awareness about correctional medicine and Corizon Health
  • Board-certified in a primary care specialty (Family Practice, Internal Medicine, Emergency
  • Medicine, or Obstetrics and Gynecology)
  • Minimum of three (3) years clinical experience required
  • License to practice medicine in state in Indiana
  • Preferred experience includes: Managed care experience or experience with a large physician group in a managerial role; three (3) years experience in correctional medicine; Formal management/leadership training; Formal training in CQI or similar (Lean, Six Sigma, etc.)
  • Demonstrated ability to meet financial targets by implementing appropriate clinical quality improvement initiatives
17

Associate Regional Medical Director Resume Examples & Samples

  • Sets and maintains clinical standards in the region by driving decisions that are patient-centered, collaborative, evidence based, and focused on both quality and utilization
  • Provides clinical leadership for statewide care management: monitors site results through data review and care management calls which decrease negative variances and promote the sharing of best practices
  • Conducts medical leadership meetings to educate team and oversee clinical quality processes, at least quarterly
  • Interprets trends and takes action at the regional level for improving health status of the population,partnering with the client to implement appropriate interventions
  • Takes action on Doctor sick call grievance trends and implements region wide process improvement
  • Mentors, monitors, and utilizes regional staff in the appropriate use of medications (formulary and non formulary) and in medication administration (e.g. side effect profile,adherence, drug/drug interactions)
  • Builds and maintains productive relationship with client leaders (including client CMO when applicable) through regular communication and face to face meetings, including one on one meetings
  • Collaborates with the contract administration team in the preparation, review and presentation of the annual client report
  • Actively participates in Clients for Life client activities
  • Collaborates with VPO, regional and site operational leaders to identify, interview, select, and retain Site Medical Directors and site physicians
  • Confirms new provider onboarding processes are completed timely and accurately for all new providers either personally and/or with Regional Medical Director (RMD)
  • On-boards, supervises and mentors Site Medical Directors in UM and QI tools, techniques and processes within the corrections environment
  • Role models and develops strong leadership and management skills in Site Medical Directors
18

Regional Medical Director Resume Examples & Samples

  • Qualified candidates must have five to ten years as a practicing physician and demonstrated administrative/managerial responsibilities in a health-care setting
  • Demonstrated knowledge and well-developed skills in
  • General medicine and pharmacology
  • Palliative medicine, pain and non-pain symptom control
  • Psychosocial and spiritual care for the dying
  • Medical management
  • Health-care law
  • Medicare and Medicaid/MediCal regulations as they relate to hospice and palliative medicine
  • Conditions of Participation in the Medicare Hospice Benefit
  • Stark regulations
19

Regional Medical Director Resume Examples & Samples

  • Networking and partnering with important external customers, including medical thought leaders, academic institutions, large group practices, medical directors, managed care decision makers, and pharmacy directors is required. Must prioritize and work effectively in a self-directed manner in a constantly changing environment. Must be able to gain, integrate, and communicate customer feedback
  • Pairing customers’ unmet needs with available resources will be a key success factor for this position. The RMD must be a strong team player who can effectively interface cross-functionally within Horizon Pharma, assuming responsibility for gaining knowledge of and collaborating with all functional areas across the company
  • Add value to Horizon Pharma-sponsored external speaker programs via identification of potential new speakers and training on scientific content
  • Participate in international, national, and regional conferences, meetings, and other scientific venues as appropriate with Horizon Pharma Medical/Clinical strategy
  • Advanced scientific or clinical degree (PhD, Pharm D, NP or MD) required
  • Five years' clinical experience with a strong current working knowledge of the healthcare and pharmaceutical environment is required. Therapeutic area knowledge and experience preferred
  • Previous pharmaceutical industry experience as an MSL or other Medical/Clinical Affairs role is strongly preferred
  • Knowledge and understanding of
20

Regional Medical Director Resume Examples & Samples

  • Development of regional and sub-regional strategies, and a plan to achieve designated utilization and quality goals/targets
  • Using data and evidence based strategies to enhance provider and facility performance in utilization and clinical quality. In particular, the short-term focus over the next few years is to substantially reduce potentially avoidable inpatient facility utilization by improving ambulatory care and optimizing the use of other sites of care
  • The RMD shares responsibility for driving regional cost of healthcare performance and monitoring the region-specific plan to ensure that the plan is executed as intended, making periodic adjustments to the plan as necessary, in order to achieve desired affordability, clinical quality and member experience targets
  • Implementing regional and sub-regional strategies
  • Development of new models for care delivery
  • Serving as the effecter for various BSC initiatives
  • Medical policy development
  • Cost of Healthcare projects
  • Clinical Quality improvement initiatives
  • Delegation oversight
  • Active, unencumbered CA license (MD or DO)
  • 5-10 years managed care experience
21

Pipc Regional Medical Director Resume Examples & Samples

  • BC MD/DO with an active unrestricted Missouri or Kansas license
  • Medical quality and performance improvement experience
  • Board certified and current active unrestricted license
  • Experience in eCW
22

Regional Medical Director Resume Examples & Samples

  • Board certified in a primary care specialty (Family Practice, Internal Medicine, Emergency Medicine, or Obstetrics and Gynecology)
  • Managed care experience or experience with a large physician group in a managerial role preferred
  • Three (3) years' experience in correctional medicine preferred
  • Formal management/leadership training preferred
  • Formal training in CQI or similar (Lean, Six Sigma, etc.) preferred
  • Oversees quality of care delivered by offsite and onsite specialists within the region
  • Identifies opportunities for enhancements and works with regional team to design and implement changes to improve efficiency in clinical operations and workflow
  • Proactively informs client of risks and high profile patient management cases and how both are being managed
  • Partners with VPO to regularly update the client as to results, improvements needed, and how we are meeting/exceeding client expectations
  • Conducts thorough and timely Peer Reviews for Medical Directors and non-physician practitioners, according to CORIZON policy and procedures
  • Builds and maintains strong relationships with site medical providers by visiting all sites
  • Improves regional results by analyzing data, developing strategies, and establishing enhanced expectations for Site Medical Directors
23

Regional Medical Director Resume Examples & Samples

  • Provide oversight and direction for the implementation of regional clinical programs and strategies, as well as, developing and implementing market level strategies
  • Support the Network Management team in both contract development and on-going delegated risk group clinical assessment efforts
  • Coordinate efforts, decisions and resources with other Humana Medical Directors as necessary (e.g. RX, Med Necessity, Transplant, COE, etc)
  • Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTACH, Acute rehab, SNF) according to the Humana Medicare Model of Care (MMOC) in all cases where Humana retains some or all of Part A risk in the contractual relationship with IPA’s/MG’s. Also use MMOC to manage HMO & POS members who utilize their out-of-network benefits
  • Participation in Quality Operations Committee, complete initial peer review on quality of care complaints, complete peer-to-peer written and verbal communications
  • Manage internal operational/functional relationships related to profitability
  • Clinical liaisons with inpatient facilities to maintain relationship and problem solve; especially reviewing contracts as to clinical services
  • Problem solving via joint operating committee’s & internal operational meetings