Remote Medicare Medical Director

Overview

The Remote Medicare Medical Director will lead medical management and quality improvement initiatives while collaborating with clinical teams and providers to enhance care for members.

In Short

• Direct and coordinate medical management and credentialing functions.
• Provide medical leadership for utilization management and quality improvement.
• Conduct medical reviews and ensure timely decision making.
• Support performance improvement initiatives for capitated providers.
• Collaborate with clinical teams and network providers.
• Participate in provider network development and market expansion.
• Review claims for medical necessity and appropriate payment.
• Develop alliances with the provider community.
• Represent the business unit on medical policies and philosophy.
• May require work on weekends and holidays.

Requirements

• Medical Doctor or Doctor of Osteopathy required.
• Utilization Management experience preferred.
• Active medical practice experience.
• Coursework in Health Administration or related fields is advantageous.
• Experience managing care for diverse populations preferred.
• Board certification in a medical specialty required.
• Current state license as MD or DO without restrictions.

Benefits

• Competitive pay and health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible work schedules including remote options.