Medical Director

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

📋 Description

• Assist the Chief Medical Officer in managing and coordinating medical operations, quality enhancement, and credentialing processes.

• Provide medical leadership for utilization management, cost-effectiveness, and quality improvement initiatives.

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

• Support the rollout of performance enhancement initiatives for capitated providers.

• Aid in formulating goals and policies aimed at enhancing the quality and cost-effectiveness of care.

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

• Assist with physician committees, focusing on structure, processes, and membership.

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

• 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 new market expansion initiatives.

• Create and implement physician education on clinical issues and policies.

• Identify opportunities for utilization review and clinical quality improvement studies.

• Assess adverse utilization trends, atypical provider practice patterns, and the adequacy of benefits/payments.

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

• Review complex, controversial, unusual, or new-service claims for medical necessity and proper payment.

• Forge provider-community partnerships through medical management programs.

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

⛳️ Requirements

• Board Certified Physician.

• Licensed to practice in the state of Georgia.

• Medical Doctor or Doctor of Osteopathy credentials.

• Currently practicing 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.

• Certification in Psychiatry specialty is mandatory.

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

• Experience in Utilization Management and familiarity with 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.

• Availability to work weekends and holidays may be necessary to support business operations.

🏝️ Benefits

• Competitive salary.

• 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 included in the overall compensation package.

• Equal opportunity employer dedicated to diversity.