Medical Director – Appeals, Managed Care, Family Medicine, Internal Medicine-Pediatrics

Job not on LinkedIn

🕒 March 23

🏄 California – Remote

🏄 California – Remote

💵 $195.2k - $341.6k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members. • Provide prior authorization medical reviews, consultation and clinical review services • Participate in peer-to-peer discussions • Provide provider education, training, data sharing, performance evaluations and orientation to the plan • Conduct clinical reviews for designated CareSource members as requested • Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns • Collaborate with market/product leaders to help define market strategy

🎯 Requirements

• Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required • Successful completion of a residency training program, preferably in primary care is required • Minimum of five (5) years of clinical practice experience is required • Managed care medical review/medical director experience is preferred • Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred • Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required • Board Certification, preferably in primary care specialty is required • MCG Certification is required or must be obtained within six (6) months of hire

🏖️ Benefits

• Comprehensive total rewards package • Health insurance • Bonuses tied to company and individual performance