Job Summary:
The Market Medical Director is responsible for the implementation of market-level clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards.
Essential Functions:
- Support staff by providing training, clinical consultation, and clinical case review for members
- Participate in Interdisciplinary Care Team meetings, Inpatient Census Rounds and other clinical meetings
- Support market provider network development and maintenance
- Provides leadership to direct reports to achieve market goals
- Provider education, training, data sharing, performance evaluations and orientation to the plan
- Participate in peer-to-peer discussions
- Participate in market level quality initiatives
- Participate in community collaboratives
- 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
- Understand and provide support to prior authorization and utilization review functions
- Conduct quality of care reviews
- Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
- Collaborates with the VP, Clinical Operations to identify utilization management and care management trends and take appropriate action
- Provides consultation to the Market Operations teams regarding coding and reimbursement policies
- Serve as chair/co-chair of Market Committees as needed
- Acts as designee for the VP, Market Chief Medical Officer as required
- Perform any other job duties 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
- Ability to analyze healthcare data from a variety of sources to evaluate physician practice patterns
- Leadership experience and skills
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
- To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
- CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
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 - $341,600.00
CareSource 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
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.
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