This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Medical Director
Location
United States
Posted
76 days ago
Salary
$195.2K - $341.6K / year
Seniority
Lead
Job Description
Medical Director
CareSource
• 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 the evaluation and investigations of cases suspected of 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 (i.e. incident management) • Provide cross-coverage for other Medical Directors and/or markets, as needed • Oversight and quality improvement activities associated with case management activities • Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate • Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards • Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives • Collaborate with market/product leaders to help define market strategy • Community collaborative participation • Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs • Perform any other job related instructions, as requested
Job Requirements
- Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine 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
- 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
- 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 (exceptions may be granted by Chief Medical Officer)
- MCG Certification is required or must be obtained within six (6) months of hire
- Basic Microsoft Word skills
Benefits
- substantial and comprehensive total rewards package
- health insurance
- retirement plans
- paid time off
- flexible work arrangements
- professional development opportunities
- bonuses
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