Medical Director

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

📋 Description

• Lead and engage in the Medical Management Program of Maryland Physicians Care MCO.

• Aid in the formulation and execution of comprehensive medical policies and standards of care.

• Provide leadership for the Health Management Teams.

• Oversee Utilization Management, Quality Management, and Inpatient Concurrent Review.

• Collaborate with healthcare providers.

• Take part in Quality Management and Utilization Management processes.

• Consult with healthcare professionals or providers regarding questions related to concurrent review.

• Conduct peer-to-peer clinical case evaluations with attending physicians, physician advisors, or ordering providers.

• Offer medical support and guidance to the Pre-Authorization Unit for elective consultations, procedures, tests, and formulary requests.

• Recognize and report issues related to quality of care.

• Engage in Grievance and Appeals Review Processes.

• Participate in QM/UM, Pharmacy and Therapeutics, and Credentialing Committees as necessary.

• Regularly round with concurrent review nurses to discuss inpatient members.

• Contribute to EQRO and HEDIS audits as required.

• Perform other assigned duties, which may include supervising nurses and associate medical directors.

⛳️ Requirements

• Unencumbered M.D. or D.O. license.

• At least five (5) years of clinical experience post-residency.

• Active Board certification.

• Background in managed care practices, processes, procedures, and operations.

• Familiarity with utilization review and management practices, processes, and procedures.

• Knowledge of local, regional, and national provider medical standards of care.

• Understanding of Medicaid and Commercial regulatory requirements is advantageous.

• Familiarity with contracts and policies related to the managed care environment.

• Ability to build and maintain effective relationships with diverse members, management, employees, and vendors.

• Proficiency in utilizing Microsoft Office Suite software applications and standard computer and office hardware.

🏝️ Benefits

• Medical, dental, and vision plans.

• 100% employer-paid Term Life Insurance.

• Short and Long-Term Disability.

• 401k Employer Match up to 4%.

• 20 days of Paid Time Off (PTO).

• Tuition assistance and professional development plans.

• Various work arrangements available.

• Organization-wide social opportunities.