Medical Director

🔥 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 as requested • Provide physician review for clinical appeals cases • Participate in evaluation and investigations of suspected fraud, abuse and quality of care concerns • Participate in development of policies and procedures • Participate in quality improvement initiatives, case management activities and member safety activities • Provide cross-coverage for other Medical Directors and/or markets as needed • Conduct oversight and quality improvement activities associated with case management activities • Review utilization data to identify variances in patterns and provide feedback and education to MCP staff and providers • Participate in development, implementation and revision of clinical care standards and practice guidelines • Participate in development, implementation and revision of the Quality Improvement Plan and corporate-level quality initiatives • Collaborate with market/product leaders to help define market strategy • Participate in community collaboratives • Support regulatory and accreditation functions, including CMS, State, NCQA and URAC compliance • Perform other job-related instructions as requested • May work evenings/weekends • May travel to fulfill position duties

🎯 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 (5) years of clinical practice experience is required • Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required • Board Certification, preferably in primary care specialty, is required • Re-certification, as required by specialty board, must be maintained • MCG Certification is required or must be obtained within six (6) months of hire • 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 • 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/problem solving skills • Conflict resolution skills • Strong sense of mission and commitment to communities served • Managed care medical review/medical director experience is preferred • Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Employee total well-being support