Medical Director

Role Overview

• Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit
• Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities
• Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services
• Supports effective implementation of performance improvement initiatives for capitated providers
• Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members
• Provides medical expertise in the operation of approved quality improvement and utilization management programs
• Assists the Chief Medical Director in the functioning of the physician committees
• Conduct regular rounds to assess and coordinate care for high-risk patients
• Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals
• Participates in provider network development and new market expansion as appropriate
• Assists in the development and implementation of physician education with respect to clinical issues and policies
• Identifies utilization review studies and evaluates adverse trends in utilization of medical services
• Interfaces with physicians and other providers to facilitate implementation of recommendations to providers that would improve utilization and health care quality

Requirements

• Medical Doctor or Doctor of Osteopathy
• Utilization Management experience and knowledge of quality accreditation standards preferred
• Actively practices medicine
• Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous
• Experience treating or managing care for a culturally diverse population preferred
• Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services
• Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules