Medical Director, Inpatient Marketplace

This is a fully remote position, open to applicants in Maine, +4 more states.

📋 Description

• Aid the Chief Medical Director in overseeing and coordinating medical management, quality enhancement, and credentialing activities.

• Offer medical leadership in areas such as utilization management, cost control, and healthcare quality improvement initiatives.

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

• Support initiatives aimed at enhancing performance for capitated providers.

• Assist in establishing objectives and policies that promote quality and cost-effectiveness in care delivery.

• Provide medical insights for quality enhancement and utilization management programs in line with regulatory, state, corporate, and accreditation standards.

• Assist with the organization of physician committees, including their structure, processes, and member selection.

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

• Collaborate with care management teams, clinical staff, network providers, appeals teams, and medical and pharmacy consultants.

• Engage in provider network development and expansion into new markets.

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

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

• Analyze adverse utilization trends, atypical provider practices, and adequacy of benefits/payments.

• Facilitate provider recommendations that aim to enhance utilization and healthcare quality.

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

• Forge alliances between providers and the community through medical management programs.

• Represent the business unit in interactions with local and national stakeholders, state committees, and ad hoc committees as required.

⛳️ Requirements

• Medical Doctor (MD) or Doctor of Osteopathy (DO).

• Currently practicing medicine.

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

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

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

• Certification in Internal or Family Medicine is preferred.

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

• Experience in treating or managing healthcare for a culturally diverse population is preferred.

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

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off along with holidays.

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

• Additional incentive options may be included in total compensation.

• Commitment to equal opportunity and diversity.