Medical Director

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

📋 Description

• Collaborate with the Chief Medical Director to oversee and coordinate medical management, quality enhancement, and credentialing activities.

• Offer medical leadership for utilization management, cost reduction, and initiatives aimed at improving medical quality.

• Conduct medical assessments for utilization review, quality assurance, and for complex, disputed, or experimental services.

• Support performance enhancement initiatives for capitated providers.

• Assist in planning objectives and policies to enhance the quality and cost-effectiveness of care.

• Provide medical insight for quality improvement and utilization management programs.

• Aid in the structure, processes, and membership of physician committees.

• Carry out regular rounds for high-risk patients and collaborate with care management teams.

• Work in conjunction with clinical teams, network providers, appeals teams, and medical and pharmacy consultants.

• Engage in provider network development and the expansion of new markets.

• Create and implement educational programs for physicians regarding clinical issues and policies.

• Identify studies for utilization review, adverse utilization trends, atypical provider practice patterns, and benefit/payment adequacy.

• Pinpoint clinical quality improvement studies aimed at reducing unnecessary variations in clinical practice.

• Interact with physicians and providers to execute recommendations that enhance utilization and healthcare quality.

• Review claims for complex, controversial, unusual, or new services to assess medical necessity and appropriate payment.

• Foster provider-community partnerships through medical management initiatives.

• Represent the business unit in front of local and national audiences, state committees, and ad hoc committees as required.

⛳️ Requirements

• Must hold a Board Certification as a Physician.

• An active MD or DO state license in New York is required.

• Medical Doctor or Doctor of Osteopathy qualification is necessary.

• Must actively practice medicine.

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

• Certification in Psychiatry specialty is mandatory.

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

• Experience in Utilization Management and knowledge of quality accreditation standards is 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.

• The ideal candidate should reside in NY or have professional ties to New York.

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

🏝️ Benefits

• Competitive compensation.

• Health insurance coverage.

• 401K and stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off along with holidays.

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

• Additional incentives may be part of the total compensation package.

• Equal opportunity employer committed to fostering diversity.