Enterprise Medical Director

🔥 2 minutes ago

🇺🇸 United States – 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

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

• Develop, implement, and revise corporate-level clinical care standards and practice guidelines • Develop, implement, and revise the Quality Improvement Plan and corporate-level quality initiatives • Develop policies and procedures • Provide medical director operational leadership and medical economics analytics • Identify utilization management trends and take appropriate action • Support regulatory, accreditation, and compliance functions for CMS, state, NCQA, and URAC programs • Provide staff training, clinical consultation, and clinical case review for members • Participate in peer-to-peer discussions • Provide provider education, training, data sharing, performance evaluations, and plan orientation • Evaluate and investigate suspected fraud, abuse, and quality-of-care concerns • Provide cross-coverage for other Medical Directors and/or markets as needed • Provide prior authorization medical reviews, consultation, and clinical review services • Conduct clinical reviews for designated CareSource members • Handle clinical appeals • Collaborate with market/product leaders to define market strategy • Provide oversight and direction to assigned managers and associates • Perform other requested job duties

🎯 Requirements

• Completion of an accredited Medical Degree program as an MD or DO is required • Successful completion of a residency training program is required; primary care preferred • Minimum of five (5) years of clinical practice experience is required • Current, unrestricted license to practice medicine in the state of practice is required • Board Certification, preferably in a primary care specialty, is required • MCG Certification is required or must be obtained within six (6) months of hire • Managed care medical review/medical director experience preferred • Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management preferred • Basic Microsoft Word skills • Excellent written and oral communication skills • Ability to work independently and within a team environment • Ability to create strong relationships with providers and members • High ethical standards and attention to detail • Critical listening and systematic thinking skills • Ability to maintain confidentiality and act in the company's best interest • Diplomacy and sensitivity to cultural diversity • Decision-making, problem-solving, and conflict-resolution skills • Ability to analyze healthcare data from varied sources to evaluate physician practice patterns • Leadership experience and skills • Ability to work evenings/weekends when required • Ability to travel as required by business needs

🏖️ Benefits

• Bonus tied to company and individual performance • Comprehensive total rewards package • Employee total well-being support • Equal Opportunity Employer environment focused on belonging and inclusion