Medical Director, Marketplace

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

📋 Description

• Collaborate with the Chief Medical Director to oversee and coordinate the medical management, quality enhancement, and credentialing processes for the business unit.

• Offer medical leadership in areas such as utilization management, cost containment, and initiatives for improving medical quality.

• Conduct medical review activities related to utilization review, quality assurance, and the review of complex, controversial, or experimental medical services.

• Facilitate the effective execution of performance improvement strategies for capitated providers.

• Assist the Chief Medical Director in strategizing and setting goals and policies aimed at enhancing quality and cost-effectiveness.

• Provide medical expertise in the implementation of sanctioned quality improvement and utilization management programs.

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

• Work in conjunction with clinical teams and providers to review complex cases and appeals.

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

• Aid in the creation and execution of physician education on clinical matters.

• Identify clinical quality improvement initiatives to help reduce unnecessary variability in clinical practices.

• Interact with physicians and providers to encourage recommendations for enhancements.

⛳️ Requirements

• Medical Doctor or Doctor of Osteopathy degree.

• Experience in Utilization Management and familiarity with quality accreditation standards is preferred.

• Currently practicing medicine.

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

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

• 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.

• Certification in Internal or Family Medicine is preferred.

• Must possess a current state license as an MD or DO with no restrictions, limitations, or sanctions from government programs.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase options.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

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