McKesson is in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. McKesson Health Solutions delivers industry-leading clinical evidence and expert technology to help payers and providers collaborate for better healthcare outcomes at lower costs. Our solutions reduce unnecessary healthcare utilization while improving outcomes; operationalize complex volume- and value-based payment models; and optimize billing communication between providers, patients and payers. Our solutions are in more than four out of five payers in the country; more than 3,900 hospitals and facilities use our InterQual® evidence-based decision support criteria; and our RelayHealth® financial solutions are used to automate 1.9 billion financial transactions each year.
We understand the importance of a system that works together. Your expertise, drive and passion can help us carry out our mission to improve lives and advance healthcare.
Join our team of leaders to begin a rewarding career.
The Medical Director for Clinical Claims Management Value team will initiate and lead client engagements related to identifying opportunities to optimize the value of ClaimsXten both for individual clients as well as the default solution. The primary focus of this role will be team-based, collaborative services engagements, leveraging the services team structure, existing and new client relationships and collaborating with the clinical development team, in particular the Medical Director for Clinical Claims Management clinical development.
Location: Remote/Telecommuter position. Must live close to a major metro airport and be willing to do 60% overnight travel. Ideally would like someone that could work out of our King of Prussia, PA office.
Client engagement and consulting:
Based on a solid understanding of payer claims processing, coding principles (e.g. CPT/HCPCS/Z-Code Identifiers), and medical policy development and management, position will drive various engagements with a variety of client areas (both in and outside of claims operations) to identify policy and editing opportunities. The Medical Director will engage with client medical directors as well as McKesson medical directors to promote enhanced editing opportunities. Team will evaluate the plans current utilization, what functionality is being overlooked and discuss recommendations to fill the gaps. Key player in driving discussions about the risks, benefits and considerations for implementing recommendations in light of the clients political, regulatory and IT environments.
Position is responsible for managing the value team resources, the clinical consulting services team and driving the consulting services engagements, collaborating with the services leadership, account management and clinical development organizations
McKesson Team Support:
Position will participate in multiple workflows and teams that touch and maintain the client rules and content in order to ensure effective optimization and alignment with client requirements. This role will also engage with the clinical development team to provide feedback on observations across clients as well as advances occurring in claims payment practices. Finally, this role will remain diligent in staying alert to new business opportunities as reimbursement models evolve.
Work with the solution design organization to provide expert Medical Director support for selling ClaimsXten and the associated knowledgepacks. Help prospects/customers understand the value of the KP, the clinical nature of the KP and the sourcing.
5+ years in managed care setting such as HMO, PPO or Utilization Management Role. Experience in working with healthcare/ clinical content and development of medical software desired.
Experience with payer organizations, medical and payment policy development, clinical claims, or revenue cycle
Involved in “cost of care” initiatives and value-based payment strategies
Strong ‘medical director’ background in health plan and claims management, exposure to policy management, outsourced retrospective recovery or waste & abuse management strategies.
Strong team and project management skills and experience.
Strong communication skills: verbal, written, and multi-media.
Strong interpersonal/relationship skills.
Personal, flexible, creative problem solving style capabilities.
Ability to project high energy and passion for the process, while sustaining a patient persistence in achieving realistic goals.
Medical Doctor Degree. MD degree with at least 10 years active clinical experience preferably in internal medicine, PCP or similar disciplines. The 10 years of experience could be a combination of clinical experience and experience as a Medical Director in a payer organization.
Medical Doctor Degree
General Office Demands
Benefits & Company Statement
McKesson believes superior performance – individual and team – that helps us drive innovations and solutions to promote better health should be recognized and rewarded. We provide a competitive compensation program to attract, retain and motivate a high-performance workforce, and it’s flexible enough to meet the different needs of our diverse employee population.
We are in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting.
But we can’t do it without you. Every single McKesson employee contributes to our mission—whatever your title, whatever your role, you act as a catalyst in a chain of events that helps millions of people all over the globe. Talented, compassionate people are the future of our company—and of healthcare. At McKesson, you’ll collaborate on the products and solutions that help us carry out our mission to improve lives and advance healthcare. Working here is your opportunity to shape an industry that’s vital to us all.
McKesson is an equal opportunity and affirmative action employer – minorities/females/veterans/persons with disabilities.
Qualified applicants will not be disqualified from consideration for employment based upon criminal history.
No agencies please.