Market Medical Director(Must Have Michigan Licensure)

CareSource • United States, United States • 16h ago

Apply (https://caresource.wd1.myworkdayjobs.com/en-US/CareSource/job/Remote/Market-Chief-Medical-Director-Must-Live-In-Michigan-_R12638/apply)

locations

Remote

time @type

Full time

posted on

Posted 30+ Days Ago

job requisition id

R12638

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

Fostering a Collaborative Workplace Culture

Cultivate Partnerships

Develop Self and Others

Drive Execution

Influence Others

Pursue Personal Excellence

Understand the Business

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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