Quartz Health Solutions

Are you a physician with experience working in a managed care setting? Are you ready to revolutionize healthcare and make a lasting impact on the well-being of communities? If so, please consider applying to Quartz as an Associate Medical Doctor.

As an Associate Medical Director specializing in Medical Management, you will be responsible for referral, prior authorization, and utilization management reviews and decisions, medical necessity determinations, and participate in quality management initiatives.

Benefits

• Unique, provider-sponsored model, enabling care and outcomes that are more integrated, less duplicative, and more lasting; with the added advantage of being aligned to some of the top hospitals and healthcare systems in the country.
• Latitude and encouragement to think differently and leave a legacy of innovation through the delivery of solutions and care models that will improve the lives of Quartz members and the overall healthcare delivery system.
• Competitive compensation and benefits package, with the flexibility to work remotely as needed
  
  

Responsibilities

• Conduct medical necessity reviews and determinations of prior authorizations and referrals, including reviews of previously denied and appealed decisions
• Offer medical expertise and guidance for utilization management decisions, member and provider grievance and appeal assessments and resolution, and quality improvement activities
• Provide clinical strategy and physician input to various health plan subcommittees, as assigned by the Senior Medical Director
  
  

Qualifications

• MD or DO with current and ongoing Board Certification in an ABMS Medical Specialty
• Unrestricted current medical license in the state of Wisconsin and other states as necessary.
• 5+ years of medical practice experience post residency or fellowship, with previous training or experience in a managed care setting preferred.
• Knowledge of medical management principles, including utilization management, prior authorization, case management, concurrent and retrospective review – including experience working with national guidelines such as MCG and InterQual
• Familiarity with the National Committee for Quality Assurance (NCQA) Health Effectiveness Data and Information Set (HEDIS) principles, accrediting requirements, and CMS Star ratings for Medicare lines of business
• Ability to plan, organize, execute assignments to meet deadlines
• Ability to communicate in a manner that builds constructive, effective relationships with colleagues across many functions, providers, and members
  
  

Quartz offers an excellent benefit and compensation package, opportunity for career advancement and a professional culture built upon the foundations of Respect, Responsibility, Resourcefulness, & Relationships. All employment offers are contingent upon successful completion of a pre-employment criminal background check and license & credential verification.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.