Job Description

Accenture is a global professional services company with leading capabilities in digital, cloud and security. Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Interactive, Technology and Operations services—all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 537,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities. Visit us at www.accenture.com.

In today’s business environment, growth isn’t just about building value—it's fundamental to long-term business survival. So how do organizations sustain themselves? The key is a new operating model—one that's anchored around the customer and propelled by intelligence to deliver exceptional experiences across the enterprise at speed and at scale. You will deliver breakthrough business outcomes for clients—by harnessing talent, data and intelligence to revolutionize their operating models.

Operations is one of four services that make up one Accenture –the others are Strategy and Consulting, Interactive and Technology.

The Medical Director provides leadership, oversight and strategic direction for health management, utilization management and care management services. Utilizing their medical expertise and knowledge of health care delivery systems, reimbursement methods, Commercial, Medicare and/or Medicaid products and managed care, the Medical Director is responsible for leading all health, medical management, and quality improvement activities. The Medical Director is a key clinical contact for health management clients as well as internal duties may include, but are not limited to the following:

Clinical Leadership

  • Provides leadership, guidance, and direction for clinical and non-clinical health management, utilization management, care management and quality improvement activities and decisions across all teams and sites, including but not limited to operations, compliance, quality, and training

  •  Oversees performance of all program metrics, including but not limited to performance, staffing, quality improvement, cost of care, utilization data, provider, member and client satisfaction

  •  Oversees analysis of medical management and quality data to identify opportunities for improvement and provides input including but not limited to the design, implementation and evaluation of corrective action plans to improve performance

  • Leads and manages the development of techniques/practices to effectively correct identified and anticipated issues while assuring consumers of care receive the care they need

  • Oversees and assists staff with the interpretation of clinical criteria and the rendering of clinical/medical necessity decisions to support consumers of care with maximizing benefits while pursuing and supporting client and company objectives

  •  Approves client’s clinical criteria for use by clinicians, provides input and/or recommends resources/references (i.e., reputable clinical websites and published articles) to optimize clinical review and training

  • Performs role in accordance with utilization management program, compliance program, and quality committee charter requirements

  • Chairs quality committee(s) and provides guidance on quality management priorities and projects

  •  Oversees and supports URAC accreditation activities, including but not limited to approval and evaluation of URAC quality improvement projects

  •  Reviews and approves governing documents, new policies, and material updates to existing policies 

  •  Provides support and oversight over Medicare compliance plan development and maintenance

  •  Participates on advisory boards, panel meetings and committees, and attends industry conferences

  • Oversees the organizational objective to have qualified clinicians that are accountable to the organization for decisions affecting health care consumers

  • Manages clinical leadership team resources, including but not limited to overall staffing, performance management, succession planning, resource optimization, and time allocation

Client Management

  •  Collaborates with client’s clinical leadership team to improve efficiency and effectiveness of services, and to identify solutions to identified issues or escalations

  •  Maintains business and industry knowledge to guide customers in strategic delivery decisions

Strategy/Innovation

  • Provides leadership in the strategic planning, strategy execution and implementation of health management, utilization management, care management and quality improvement programs

  • Participates in strategic planning for existing and expanding business including setting growth objectives, contributing to strategy, building internal and client relationships, and supporting sales pursuits including RFP inputs, client meetings, and site visits

  • Actively participates during sales presentations and provides subject matter expertise on medical policy and medical-related issues

  •  Recommends changes in program content in concurrence with changing markets, technologies, and evidence-based practice

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Qualifications

Basic Qualifications

  • Doctor of Medicine, MD or Doctor of Osteopathy, DO

  • Active, unrestricted license to practice medicine, issued by a U.S. State Board of Medicine or State Board of Osteopathic Medicine

  • Hold state specific MDDO licensure as required

  • Minimum of 5 years of experience in medical management or health administration in a managed care or hospital environment for Commercial, Medicare and/or Medicaid lines of business

  • Minimum of 3 years in of experience in a Medical Director role

  • Minimum of 3 years of experience in medical management healthcare administration in a managed care environment

Preferred Qualifications

  • Experience in leading managed care quality improvement programs

  • Ability to interpret and apply medical policy

  • Broad clinical knowledge and understanding of current health care and health system issues

  • Strong strategic thinking ability and business acumen

  • Demonstrated client relationship building skills

  • Demonstrated ability to serve as a physician SME during meetings with clients, prospective clients or industry leaders

  • Flexibility to travel domestically and internationally, as required

  • Must be comfortable working in a global matrixed organization

  • Demonstrated leadership and teamwork in professional setting

  • Certification in a recognized medical specialty as recognized by the American Board of Medical Specialists or the American Board of Osteopathic Specialists ABMSABOS

  • Masters in Public Health or Business Administration

  •  NCQAURAC and Medicare experience

  • Knowledge of Six Sigma and Lean concepts and methodologies

  • Board Certification by the American Board of Quality Assurance and Utilization Review Physician ABQAURP or the American Board of Medical Management

  • Experience creating and articulating the client value proposition of services



COVID-19 update:


The safety and well-being of our candidates, our people and their families continues to be a top priority. Until travel restrictions change, interviews will continue to be conducted virtually.


Subject to applicable law, please be aware that Accenture requires all employees to be fully vaccinated as a condition of employment. Accenture will consider requests for accommodation to this vaccination requirement during the recruiting process.


What We Believe


We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Accenture has the responsibility to create and sustain an inclusive environment.


Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities. Read more here


Equal Employment Opportunity Statement


Accenture is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion or sexual orientation.


All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.


Accenture is committed to providing veteran employment opportunities to our service men and women.


For details, view a copy of the Accenture Equal Opportunity and Affirmative Action Policy Statement.


Requesting An Accommodation


Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.


If you would like to be considered for employment opportunities with Accenture and have accommodation needs for a disability or religious observance, please call us toll free at 1 (877) 889-9009, send us an email or speak with your recruiter.


Other Employment Statements


Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.


Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.


Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.


The Company 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. Additionally, 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 Company's legal duty to furnish information.

Locations

AZ - Phoenix,CA - San Francisco,CA - San Jose,CO - Denver,GA - Atlanta,IL - Chicago,NC - Charlotte,NJ - Florham Park,PA - Philadelphia,TX - Austin,TX - Houston,TX - Irving,VA - Arlington,WA - Seattle

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