Medical Director

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

📋 Description

• Assist the Chief Medical Director in overseeing and coordinating medical management, quality enhancement, and credentialing functions.

• Provide medical leadership in utilization management, cost control, and initiatives aimed at improving medical quality.

• Conduct medical reviews for utilization assessments, quality assurance, and complex, controversial, or experimental medical services.

• Support performance improvement initiatives for capitated providers.

• Aid in the planning of goals and policies to enhance the quality and cost-effectiveness of care and services.

• Offer medical expertise for quality enhancement and utilization management programs in compliance with regulatory, state, corporate, and accreditation standards.

• Assist with physician committees, including their structure, processes, and membership.

• Conduct regular assessments to coordinate care for high-risk patients alongside care management teams.

• Collaborate with clinical teams, network providers, appeals teams, and medical and pharmacy consultants on complex cases and medical necessity appeals.

• Engage in provider network development and expansion into new markets.

• Assist with educating physicians on clinical issues and policies.

• Identify utilization review studies and analyze adverse utilization trends, unusual provider practices, and benefit/payment adequacy.

• Identify clinical quality enhancement studies aimed at reducing unwarranted variations in clinical practices.

• Interface with physicians and providers to implement recommendations that enhance utilization and healthcare quality.

• Review complex, controversial, unusual, or new-service claims to assess medical necessity and appropriate compensation.

• Build alliances with the provider community through medical management programs.

• Represent the business unit in interactions with local and national stakeholders and at state or ad hoc committees as required.

⛳️ Requirements

• Must possess Board Certification as a Physician.

• Must hold a license to practice in the state of Arizona.

• Medical Doctor or Doctor of Osteopathy qualification is required.

• Board certification in a medical specialty acknowledged by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services is necessary.

• Certification in the Psychiatry specialty is mandatory.

• Current state license as an MD or DO without any restrictions, limitations, or sanctions from government programs.

• Must be actively practicing medicine.

• Experience and knowledge in Utilization Management and quality accreditation standards are preferred.

• Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.

• Experience in treating or managing care for a culturally diverse population is preferred.

• Availability to work weekends and holidays as required may be necessary.

🏝️ Benefits

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.