Medical Director

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

📋 Description

• Conduct prior authorization medical reviews, consultations, and clinical review services.

• Engage in peer-to-peer discussions.

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

• Execute clinical reviews for designated CareSource members.

• Carry out physician reviews for clinical appeals cases.

• Participate in investigations related to fraud, abuse, and quality of care.

• Formulate policies, procedures, clinical care standards, practice guidelines, and quality improvement plans.

• Engage in quality improvement initiatives, case management, member safety, regulatory compliance, and accreditation activities.

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

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

• Collaborate with market and product leaders to establish market strategies.

• Participate in community collaboratives.

• Carry out other job-related tasks as requested.

⛳️ Requirements

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

• Successful completion of a residency training program, preferably in primary care, is required.

• A minimum of five years of clinical practice experience is essential.

• A current, unrestricted license to practice medicine in the state of practice, as mandated by regulatory requirements, is necessary.

• Board Certification, ideally in a primary care specialty, is required.

• Maintenance of re-certification as mandated by the specialty board is necessary.

• MCG Certification is required or must be obtained within six months of hiring.

• Proficiency in basic Microsoft Word skills.

• Exceptional written and verbal communication skills.

• Capability to work independently as well as collaboratively within a team environment.

• Ability to cultivate strong relationships with providers and members.

• High ethical standards.

• Strong attention to detail.

• Excellent critical listening and systematic thinking abilities.

• Capacity to maintain confidentiality and act in the organization's best interests.

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

• Proficient decision-making, problem-solving, and conflict-resolution skills.

• Commitment to enhancing the communities served.

• Flexibility to work evenings and weekends may be required.

• Willingness to travel may be required.

🏝️ Benefits

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

• A comprehensive total rewards package.

• Support for employee well-being.

• An equal opportunity and inclusive workplace environment.