Medical Director

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $195.2k - $341.6k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Provide subject matter expertise and medical leadership for utilization management, care management, and quality-of-care programs for infant and neonatology services • Collaborate with Utilization Management and Care Management leadership and Medical Directors to achieve utilization, care management, and quality-of-care objectives • Provide clinical training, consultation, case reviews, prior authorization medical reviews, and peer-to-peer discussions • Provide provider education, training, data sharing, performance evaluations, and orientation • Review clinical appeals and investigate suspected fraud, abuse, and quality-of-care concerns • Participate in quality improvement, case management, member safety, and incident management activities • Review utilization data, identify pattern variances, and provide feedback and education • Develop, implement, and revise clinical care standards, practice guidelines, Quality Improvement Plans, and corporate quality initiatives • Collaborate with market and product leaders on market strategy • Liaise with community-based organizations and health systems regarding neonatal care, prevention, care coordination, and management • Support regulatory, accreditation, and compliance functions involving CMS, state requirements, NCQA, and URAC • Participate in Utilization Management rounds and educate staff on NICU utilization management, levels of care, and quality of care • Improve transitions of care for NICU members graduating from the NICU • Create formal clinical policy for NICU and post-NICU transitions and care management • Perform other job duties as requested

🎯 Requirements

• Completion of an accredited Medical Degree program as an MD or DO is required • Successful completion of a pediatrics residency and neonatology fellowship, or equivalent experience, is required • Minimum five years of clinical practice experience is required • Current, unrestricted license to practice medicine in the state of practice is required • Board certification in a primary care specialty, preferably Pediatrics, and board certification in Neonatology are required • Maintain specialty-board recertification as required • Basic Microsoft Word skills • Excellent written and oral communication skills • Ability to work independently and within a team environment • Ability to build strong relationships with providers and members • High ethical standards • Attention to detail • Critical listening and systematic thinking skills • Ability to maintain confidentiality and act in the company’s best interest • Ability to act with diplomacy and sensitivity to cultural diversity • Decision-making and problem-solving skills • Conflict-resolution skills • Commitment to the communities served • May be required to work evenings and weekends • May be required to travel to fulfill position duties

🏖️ Benefits

• Potential bonus tied to company and individual performance • Substantial and comprehensive total rewards package • Employee well-being support • Work-from-home arrangement indicated by the Delaware WFH location