Description |
As the world's largest healthcare services company with more than $100 billion in annual sales, McKesson Corporation (McKesson) is a Fortune 15 Corporation that provides pharmaceutical supply management and information technologies across the entire continuum of healthcare.
This opportunity is within the McKesson Health Solutions, Medical Management Group (MMG). The MMG offers a comprehensive suite of medical management products and services to help providers and payers better manage the cost and quality of care. Its CareEnhanceSM and InterQual solutions include: disease management, nurse triage, care management, utilization management, decision support criteria, and software that helps manage workflow, resources, and regulatory reporting processes.
Current Need
The Claims Performance group of McKesson Health Solutions (division of McKesson Corporation) is seeking a Medical Director who enjoys systems thinking and complex problem-solving with a strong customer orientation and attention to detail in claims management and payment policy. This individual should have a strong background in medical management, medical and payment policy development, claims processing and performance; experience with the management and oversight of fraud and abuse programs is very desirable. Demonstrable experience with clinical analytics and customer-centered relationship management is strongly desired. The ideal candidate will be familiar with claims auditing logic and software concepts; explicit business software expertise is not required (e.g. beyond Microsoft Office Suite). Familiarity with various health plan lines of business (including commercial FFS, managed care programs, Medicare Advantage, and Medicaid with respect to claims management strategy and policy) is required.
This position will involve major input into the design and implementation of KnowledgeBase content for cutting edge customer decision support and auditing logic solutions that build on existing business intelligence capabilities and optimize product value for our clients. Additional accountabilities also exist to the sales and solution support teams, other cross-McKesson initiatives, and outside professional organizations.
The candidate's principal job responsibilities will support development of McKesson Health Solution's suite of software products. The following competencies are desired:
- A thorough understanding of the medical claims submission and appeals process - with a solid conceptual understanding of health information systems and technology; `hands-on¿ experience with claims management and claims auditing software is highly desirable. A thorough understanding of CPT coding is essential; formal ¿coding certification¿ is a `plus¿ but is not required.
- Familiarity with the business and clinical literatures needed to supplement and support changes to McKesson knowledge base content as a result of clinical reviews; coding system updates; coding guidelines and customer interactions; and other sources of external input.
- Technical writing experience necessary to create and manage user documentation related to revisions and enhancements of the KnowledgeBase releases for customers and other key stakeholders.
- A desire and ability to work directly with McKesson customers to improve Claims Performance solutions. In addition to direct support of McKesson products, this may include review and revision of health plan medical and payment policies; review, analysis and redesign of claim auditing processes; and recommendations for innovative customization of software to recognize emerging claims processing opportunities.
- Experience with fraud and abuse detection and management at the health plan level.
- Meeting leadership and facilitation skills in a variety of settings including clinical consultant panel meetings for product knowledge bases, medical informatics, the proper use of clinical and health care industry guidelines, and a variety of business-related content areas.
- Strong presentation and interpersonal skills; this role will have a strong customer relationship component.
- Experience with large corporate organizations from senior leadership discussions regarding corporate strategic plans and objectives to problem solving sessions with line level employees across the organization.
- An ability and desire to assist/conduct process design sessions at client sites (identifying process efficiencies and solutions through the use of McKesson products and services).
- Familiarity with quality improvement and corporate risk management at all levels.
- Additional responsibilities, as required, by management.
At times, this individual will work independently and autonomously; at other times, this role be tightly coupled to dynamic team functions where information sharing is paramount. The candidate must possess excellent written, verbal, and presentation skills and must be prepared to travel on a routine basis (up to 40% of total time).
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Requirements |
Minimum Requirements
- Medical Degree (MD or DO)
- Demonstrated in-depth knowledge of clinical information technology, healthcare finance and reporting, utilization management programs, quality improvement programs and contracting, including major suppliers, products, services, industry initiatives/drivers, challenges, barriers, etc
- Minimum 5 years experience utilizing clinical information technology in the healthcare environment
- Experience/demonstrated knowledge in the development of data-driven utilization management and quality management programs
- Experience organizing and facilitating focus groups
- Knowledge of health plan initiatives relative to utilization and quality control
- Experience in organizational and behavioral change management
- Demonstrated leadership skills, particularly in the area of leading cultural change in adoption of computerization
- Excellent communication skills
- Ability to influence peers
- Travel: variable; may involve 30-40% of total work effort.
- Physical Requirements: General office demands. Demonstrate proficiency in the use of standard business software is required (e.g. Microsoft Office). Specific claims management software experience is desirable but not required.
- Additional responsibilities may be further developed and assigned from time to time by the senior management team.
Additional Knowledge & Skills
- Experience serving as the Chief Medical Officer (CMO), Vice President of Medical Affairs (VPMA), or Medical Director of a mid- to large-sized health plan
- Knowledge & familiarity with McKesson payor solutions.
Physical Requirements
General office demands
Location: Remote/Nationwide
Travel: Variable: up to 40%
Company Statement
McKesson offers a competitive compensation and benefits package.
McKesson is everywhere in healthcare. We offer a wealth of opportunity for individuals with a desire to make a difference in providing industry-leading, integrated healthcare services and solutions. Individuals with the passion to be a part of our entire continuum of patient-focused care. It's you and McKesson - empowering healthcare.
As an equal opportunity employer, McKesson Corporation unites the talents and contributions of all to advance the power of healthcare.
Agency Statement
No agencies please.
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