Medical Director

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

📋 Description

• Offer expert knowledge and medical leadership for utilization management, care management, and quality-of-care initiatives for infant and neonatology services.

• Collaborate with leadership in Utilization Management and Care Management, as well as Medical Directors, to meet goals related to utilization, care management, and quality of care.

• Deliver clinical training, consultations, case reviews, prior authorization medical evaluations, and peer discussions.

• Provide education and training for providers, share data, conduct performance assessments, and facilitate orientation.

• Examine clinical appeals and probe into suspected fraud, abuse, and quality-of-care issues.

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

• Analyze utilization data, detect pattern variances, and offer constructive feedback and education.

• Create, implement, and update clinical care standards, practice guidelines, Quality Improvement Plans, and corporate quality initiatives.

• Work alongside market and product leaders to develop market strategies.

• Act as a liaison with community organizations and health systems regarding neonatal care, prevention, care coordination, and management.

• Assist in regulatory, accreditation, and compliance responsibilities involving CMS, state regulations, NCQA, and URAC.

• Participate in Utilization Management rounds and provide education to staff on NICU utilization management, levels of care, and quality of care.

• Enhance transitions of care for NICU members transitioning out of the NICU.

• Establish formal clinical policies for NICU and post-NICU transitions and care management.

• Undertake additional job responsibilities as assigned.

⛳️ Requirements

• A completed and accredited Medical Degree program as an MD or DO is mandatory.

• Successful completion of a pediatrics residency and neonatology fellowship, or equivalent experience, is required.

• At least five years of clinical practice experience is necessary.

• A current, unrestricted license to practice medicine in the relevant state is required.

• Board certification in a primary care specialty, preferably Pediatrics, along with board certification in Neonatology, is essential.

• Maintenance of specialty-board recertification as required.

• Basic skills in Microsoft Word.

• Exceptional written and verbal communication abilities.

• Capability to work autonomously as well as collaboratively within a team.

• Proficiency in building strong relationships with providers and members.

• High ethical standards.

• Strong attention to detail.

• Critical listening and systematic thinking capabilities.

• Ability to uphold confidentiality and act in the best interests of the company.

• Skills in diplomacy and sensitivity to cultural diversity.

• Competence in decision-making and problem-solving.

• Proficiency in conflict-resolution.

• Commitment to serving the communities involved.

• Availability to work evenings and weekends may be necessary.

• Travel may be required to fulfill job responsibilities.

🏝️ Benefits

• Potential bonus based on company and individual performance.

• Comprehensive and substantial total rewards package.

• Support for employee well-being.

• Work-from-home arrangement as indicated by the Delaware WFH location.