Enterprise Medical Director
Location
United States
Posted
10 days ago
Salary
$195.2K - $341.6K / year
Seniority
Lead
Job Description
Enterprise Medical Director
CareSource
• Development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives • Development of policies and procedures • Medical Director Operational leadership, Medical Economics Analytics • Identify utilization management trends and take appropriate action • Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs • Support staff by providing training, clinical consultation, and clinical case review for members • Participate in peer-to-peer discussions • Provide provider education, training, data sharing, performance evaluations and orientation to the plan • Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns • Provide cross-coverage for other Medical Directors and/or markets, as needed • Provide prior authorization medical reviews, consultation and clinical review services • Conduct clinical reviews for designated CareSource members • Collaborate with market/product leaders to help define market strategy • Provides oversight and direction of assigned managers and associates • Perform any other job duties 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
- MCG Certification is required or must be obtained within six (6) months of hire
Benefits
- substantial and comprehensive total rewards package
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