Medical Director

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist staff through training, clinical consultations, and case reviews for members.

• Deliver clinical review services as instructed.

• Engage in peer-to-peer discussions.

• Offer provider education, training, data sharing, performance assessments, and orientation to the plan.

• Conduct clinical reviews for assigned CareSource members.

• Provide physician evaluations for clinical appeal cases.

• Contribute to the evaluation and investigation of suspected fraud, abuse, and quality-of-care issues.

• Participate in the development of policies and procedures.

• Engage in quality improvement initiatives, case management efforts, and member safety activities.

• Provide cross-coverage for other Medical Directors and/or markets as necessary.

• Supervise and support quality improvement activities linked to case management.

• Analyze utilization data to identify pattern variances, offering feedback and education to MCP staff and providers.

• Develop, implement, and update clinical care standards and practice guidelines in accordance with nationally accepted quality standards.

• Formulate, implement, and revise the Quality Improvement Plan and corporate-level quality initiatives.

• Collaborate with market/product leaders to help define market strategy.

• Participate in community collaboratives.

• Assist with regulatory and accreditation functions and compliance for CMS, State, NCQA, and URAC programs.

• Perform additional job-related duties as assigned.

• Availability to work evenings and weekends may be required.

• Must be able to sit or stand for extended periods in a general office setting.

⛳️ Requirements

• Doctor of Osteopathic Medicine (DO) or Medical Doctor (MD) is required.

• Completion of a residency training program, preferably in primary care, is necessary.

• A minimum of five (5) years of clinical practice experience is required.

• A current, unrestricted license to practice medicine in the state of practice is essential to meet regulatory requirements.

• Board Certification in a primary care specialty is preferred.

• Re-certification as required by specialty board must be maintained; exceptions may be granted by the Chief Medical Officer.

• MCG Certification is required or must be obtained within six (6) months of employment.

• Basic Microsoft Word skills are necessary.

• Excellent written and verbal communication skills are required.

• Ability to work both independently and collaboratively in a team setting.

• Strong relationship-building skills with Providers and Members.

• High ethical standards are a must.

• Attention to detail is crucial.

• Critical listening and systematic thinking abilities are necessary.

• Capacity to maintain confidentiality and act in the company's best interest.

• Ability to act with sensitivity and diplomacy regarding cultural diversity.

• Strong decision-making and problem-solving capabilities.

• Conflict resolution skills are essential.

• A strong sense of mission and commitment to enhancing the communities served.

• A Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration, or Medical Management is preferred.

• Experience in managed care medical review or as a medical director is preferred.

🏝️ Benefits

• Bonus opportunities linked to company and individual performance may be available.

• A substantial and comprehensive total rewards package is offered.

• Up to 15% occasional travel for meetings, training sessions, and conferences.