Remote Market Place Medical Director

Overview

As a clinical professional on the Medical Management/Health Services team, you will assist the Chief Medical Director in directing and coordinating medical management and quality improvement functions, impacting 28 million members.

In Short

• Direct and coordinate medical management and quality improvement functions.
• Provide medical leadership for utilization management and cost containment.
• Perform medical review activities for complex and controversial services.
• Support performance improvement initiatives for capitated providers.
• Collaborate with clinical teams and network providers.
• Conduct regular rounds for high-risk patient care coordination.
• Participate in provider network development and market expansion.
• Assist in physician education on clinical issues and policies.
• Review claims for medical necessity and appropriate payment.
• Develop alliances with the provider community.

Requirements

• Medical Doctor or Doctor of Osteopathy required.
• Utilization Management experience preferred.
• Active practice of medicine is necessary.
• Coursework in Health Administration or related fields is advantageous.
• Experience with culturally diverse populations preferred.
• Board certification in a recognized medical specialty.
• Current unrestricted state license as MD or DO.

Benefits

• Competitive pay and comprehensive benefits package.
• Health insurance and 401K plans.
• Tuition reimbursement and paid time off.
• Flexible work schedules including remote options.
• Equal opportunity employer committed to diversity.