Medical Director

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

📋 Description

• Assist the Chief Medical Director in overseeing and coordinating the medical management, quality enhancement, and credentialing operations for the business unit.

• Provide medical leadership for all activities related to utilization management, cost control, and improvements in medical quality.

• Conduct medical reviews associated with utilization assessments, quality assurance, and the evaluation of complex, controversial, or experimental medical services.

• Facilitate the effective implementation of performance improvement initiatives for capitated providers.

• Support the Chief Medical Director in planning and setting goals and policies aimed at enhancing the quality and cost-efficiency of care and services for members.

• Perform regular rounds to evaluate and coordinate care for high-risk patients.

• Collaborate effectively with clinical teams, network providers, the appeals team, and medical and pharmacy consultants to review complex cases and medical necessity appeals.

• Engage in provider network development and new market expansion as appropriate.

• Review claims involving complex, controversial, or unusual services to determine medical necessity and suitable payment.

⛳️ Requirements

• MD or DO with no restrictions.

• Must hold a valid medical license in Oklahoma.

• Board Certified Physician.

• Preferred experience in Utilization Management and knowledge of quality accreditation standards.

• Must be actively practicing medicine or have been an actively practicing physician within the last five years.

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

• Preferred experience in treating or managing care for a culturally diverse population.

🏝️ Benefits

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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