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Medical Director(Must Live In Massachusetts)

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 1,001-5,000Since 30+ yearsH1B SponsorCompany SiteLinkedIn

Location

United States

Posted

82 days ago

Salary

$195K - $341K / year

Seniority

Lead

No structured requirement data.

Job Description

Medical Director(Must Live In Massachusetts)

CareSource

Job Summary: The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members. Essential Functions: - 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 - Participates 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 Education and Experience: - 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 Competencies, Knowledge and Skills: - Basic Microsoft Word skills - Excellent communication skills, both written and oral - Ability to work well 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 of time, effort and resources to the betterment of the communities served Licensure and Certification: - 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 Working Conditions: - General office environment; may be required to sit or stand for extended periods of time - May be required to work evenings/weekends - May be required to travel to fulfill duties of position Compensation Range: $195,200.00 - $341,600.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business 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. #LI-SW2

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Johnson & Johnson Innovative Medicine logo

Associate Director, Medical Science Liaison, Cardiac Electrophysiology for Texas Region

Johnson & Johnson Innovative Medicine

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity.

Medical Director82 days ago
Full TimeRemoteTeam 10,001

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at jnj.com As guided by Our Credo, Johnson & Johnson is responsible to our employees who work with us throughout the world. We provide an inclusive work environment where each person is considered as an individual. At Johnson & Johnson, we respect the diversity and dignity of our employees and recognize their merit. Job Function: Medical Affairs Group Job Sub Function: Medical Science Liaison Job Category: People Leader All Job Posting Locations: Irvine, California, United States of America Job Description: Johnson and Johnson is currently seeking an Associate Director, Medical Science Liaison, Cardiac Electrophysiology for the Texas Region. Candidate should be based in close proximity to Texas. At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at https://www.jnj.com/. 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Johnson & Johnson is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, protected veteran status or other characteristics protected by federal, state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act. Johnson & Johnson is committed to providing an interview process that is inclusive of our applicants’ needs. If you are an individual with a disability and would like to request an accommodation, external applicants please contact us via https://www.jnj.com/contact-us/careers . internal employees contact AskGS to be directed to your accommodation resource. Required Skills: Preferred Skills: Clinical Research and Regulations, Clinical Trials, Customer Centricity, Data-Driven Decision Making, Developing Others, Digital Culture, Digital Literacy, Inclusive Leadership, Leadership, Medical Affairs, Medical Communications, Medical Compliance, Performance Measurement, Product Knowledge, Relationship Building, Research and Development, Scientific Communications, Strategic Thinking, Team Management The anticipated base pay range for this position is : $137,000.00 - $235,750.00 Additional Description for Pay Transparency:

United States
$137K - $237K / year
Job Closed

Associate Director, Medical Affairs Governance

Revolution Medicines

Revolution Medicines (RevMed) is committed to revolutionizing treatment for patients with RAS-addicted cancers, specializing in oncology drug discovery and development. With the mi

Medical Director82 days ago

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Full TimeRemoteTeam 1,001-5,000Since 1980H1B Sponsor

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United States
Job Closed
UPMC logo

Medical Director, Utilization Management - Temporary

UPMC

UPMC is an Equal Opportunity Employer/Disability/Veteran.

Medical Director82 days ago
Full TimeRemoteTeam 10,001

Purpose: The UPMC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director, Utilization Management role. The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC Health Plan members. They will be responsible for assuring physician commitment and delivery of comprehensive high quality health care to UPMC Health Plan members. They will oversee adherence to quality and utilization standards through committee delegations and further establish an effective working relationship between UPMC Health Plan's Network and its physicians, hospitals and other providers. UPMC offers a premier benefits package, designed to care for your total well-being — physically, emotionally, and financially — paired with endless opportunities for career advancement and growth. Discover the culture, the teams, and the passions that drive us to make Life Changing Medicine happen. This is a Temporary Full-Time, Full-Remote role. Responsibilities: - Actively participates in the daily utilization management and quality improvement review processes, including concurrent, prospective and retrospective reviews, member grievances, provider appeals, and potential quality of care concerns. - Provide expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan.\ - Keep current with accepted standards and professional developments in the areas of quality improvement and utilization management. - Communicate and educate network providers regarding clinical guidelines, pathways, protocols, and standards related to quality and utilization processes. - Interacts with physicians regarding opportunities to improve member satisfaction and compliance with Utilization Management and Quality Improvement policies and procedures. - Contributes to process improvement within the Utilization Management department. - Participates in activities to support policy decision making. - Utilizes clinical experience to support departmental reviews. - This position requires a Doctor of Medicine or Doctor of Osteopathy from an accredited school - PA Medical license Required - The ideal candidate will have 5-10 years of clinical experience, as well as managed care experience - Internal Medicine, Family Medicine, or Emergency Medicine highly preferred - Licensure, Certifications, and Clearances: - Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO) - Pennsylvania Medical License UPMC is an Equal Opportunity Employer/Disability/Veteran

United States