Medical Director – Clinical Ops Case Review

🕒 4 days ago

🏈 Alabama, Arizona, +16 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🌾 Nebraska – Remote 🌾 North Dakota – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

💵 $235.6k - $319.8k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Medica

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1975

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

Medica is a nonprofit health plan and insurer with over 50 years of experience that provides individual & family plans, Medicare, Medicaid, and employer-provided health plans. It offers member services and tools for finding providers, managing benefits and claims, wellness programs, and community-focused initiatives through the Medica Foundation to advance health equity.

📋 Description

• support care management, quality, utilization management, credentialing, pharmacy, health policy implementation, technology assessment and risk management activities • Completes care management case review for cases involving medical necessity review • Completes appeal case review for cases involving medical necessity review • Partners to establish priorities as appropriate for improving service at the point of care • Completes quality of care complaint reviews for cases involving clinical aspects or clinical/service aspects • Participates in rotation to above Committee Participation

🎯 Requirements

• Medical Doctorate (MD) or Doctor of Osteopathic Medicine (DO) • 10+ years of experience beyond degree • 5+ years of leadership experience • Must be a licensed physician with current Board certification of ABMS recognized specialty • Current medical license to practice must be without restrictions • Must be willing and able to successfully apply for medical license in other states as needed

🏖️ Benefits

• competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees