Medical Director

Job not on LinkedIn

🔥 0 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

• 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 • Perform physician review for clinical appeals cases • Participate in evaluations and investigations of suspected fraud, abuse, and quality-of-care concerns • Develop policies and procedures • Participate in quality improvement, case management, and member safety activities • Provide cross-coverage for other Medical Directors and/or markets as needed • Oversee and improve case management activities • Review utilization data to identify pattern variances and provide feedback and education • Develop, implement, and revise clinical care standards and practice guidelines • Develop, implement, and revise the Quality Improvement Plan and corporate quality initiatives • Collaborate with market and product leaders to help define market strategy • Participate in community collaborations • Support regulatory, accreditation, and compliance functions for CMS, State, NCQA, and URAC programs • Perform other job-related instructions as requested

🎯 Requirements

• Completion of an accredited Medical Degree program as an MD or DO is required • Successful completion of a residency training program, preferably in primary care, is required • Minimum of five years of clinical practice experience is required • Current, unrestricted license to practice medicine in the state of practice is required as necessary to meet regulatory requirements • Board Certification, preferably in a primary care specialty, is required • Specialty-board recertification must be maintained when required • MCG Certification is required or must be obtained within six months of hire • Basic Microsoft Word skills • Excellent written and oral communication skills • Ability to work independently and within a team environment • Ability to build 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 • Commitment of time, effort, and resources to communities served • May be required to work evenings and weekends • May be required to travel to fulfill position duties

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Employee well-being support • Equal Opportunity Employer environment focused on belonging and support