Medical Director

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

📋 Description

• Support the Chief Medical Officer in overseeing and coordinating physician-related aspects of utilization management for health plan business units.

• Provide medical leadership for activities related to utilization management and medical reviews.

• Conduct medical reviews of complex, controversial, experimental, or atypical services, including transplants, enlisting consultants as necessary.

• Carry out case reviews and appeals for all health plans.

• Assist the CMO in establishing goals and policies aimed at enhancing the quality and cost-effectiveness of care and services.

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

• Identify and evaluate utilization review studies, adverse utilization trends, unusual provider practice patterns, and the adequacy of benefits and payments.

• Identify clinical quality improvement projects to minimize unwarranted variations in clinical practice.

• Assess claims related to complex, controversial, unusual, or new services to determine medical necessity and appropriate payment.

⛳️ Requirements

• Board Certified Physician.

• Active Indiana MD or DO state license required.

• Current Indiana medical license must be unrestricted.

• Board Certification from the American Board of Medical Specialties.

• Must possess either a Medical Doctor or Doctor of Osteopathy degree.

• Preferably board certified in a primary care specialty (Internal Medicine, Med/Peds, Family Practice, Pediatrics, or Emergency Medicine) or another specialty that is familiar with Medicare patients.

• Experience in utilization management is highly desirable.

• Previous experience in a managed care organization 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.

• Must be an actively practicing physician.

• Holding licenses from more than one state is preferred.

• Availability of approximately 20 hours per week, with Thursdays and Fridays being the highest priority.

🏝️ Benefits

• Competitive compensation.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans available.

• Tuition reimbursement offered.

• Paid time off in addition to holidays.

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

• Additional incentives may be included in total compensation.

• Equal opportunity employer dedicated to promoting diversity.