Medical Director – Health Plan

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🏈 Alabama, Arizona, +30 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🤠 Texas – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $238.4k - $294.5k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 0%

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Martin's Point Health Care

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🛡️ Insurance

📦 Logistics

💼 Consulting

Insurance • Logistics • Consulting

Martin's Point Health Care is a healthcare organization committed to serving its local communities through high-quality primary and specialty care services. The organization places a strong emphasis on creating a positive workplace culture, recognizing employee contributions, and fostering workforce diversity. Martin's Point Health Care offers a range of career opportunities across various departments, from healthcare providers to corporate roles, and supports employee growth through competitive compensation, development programs, and generous perks. Additionally, the company is recognized for its community impact efforts, raising significant funds for community organizations and encouraging employee volunteerism.

📋 Description

• Provides professional leadership and direction to utilization and cost management and clinical quality management functions of Martin’s Point Health Plans • Works collaboratively with Health Management, Quality, Network Management, Member Services, benefits and claims management, and Compliance • Assists in short- and long-range program planning, quality management, and external relationships • Serves as a key implementer of the Health Plan’s Triple Aim strategy, driving the cost management component • Helps manage health plan medical costs by assuring clinically appropriate health care delivery for health plan products and services • Performs medical necessity reviews of requests for health plan-covered services • Reviews disputes and appeals for clinical appropriateness • Contributes to case reviews to ensure quality and safety of care and services delivered to members • Assists in constructing annual Utilization Management, Care Management, and Disease Management Program Descriptions and ensures programs meet accreditation and regulatory standards, including NCQA, CMS, and TRICARE • Participates in medical policy review and policy development • Works with Informatics, Network Management, and Medical Economics to assess network providers regarding cost management and develop communication plans for outliers • Develops an in-depth understanding of ACOs and contributes to their management and strategic deployment • Provides support to Health Plan risk adjustment activities as needed • Applies knowledge of Health Plan goals and strategic initiatives, including utilization and cost management, MLR, inpatient days/1000, SNF days/1000, and HEDIS-related clinical quality improvement objectives • Reports to the VP Medical Director and works closely with other Health Plan leaders

🎯 Requirements

• MD/DO • Active and unrestricted license to practice medicine in Maine or New Hampshire; or another U.S. state with eligibility to apply for and obtain additional state licensure • Board certified physician • Post-graduate experience in direct patient care required • 2-5 years of experience in utilization management in a health plan setting is preferred • Knowledge of process improvement tools • Deep knowledge and practical understanding of health care systems and managed care concepts • Knowledge and deep commitment to performance-based Health Plan systems • Good analytic skills with the ability to identify meaningful trends and targets for improvement • Excellent interpersonal skills and demonstrated ability to establish rapport and working relationships with providers, service vendors and internal staff • Demonstrated ability to manage and develop staff • Willingness to explore innovative methods of providing medical management • This position is not eligible for immigration sponsorship

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Retirement savings with employer contributions • Paid time off • Volunteer time off • Pie day • Other employee benefits • Additional compensation, including incentive or commission-based programs, where applicable