CareSource

Medical Director – Geriatrics, Internal Medicine, Family Practice Preferred

CareSource

full-time

Posted on:

Origin:  • 🇺🇸 United States • Ohio

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Salary

💰 $191,400 - $334,900 per year

Job Level

Entry Level

About the role

  • Participate in development, implementation and revision of clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
  • Collaborate with market/product leaders to help define market strategy
  • Represent CareSource at state and regulatory venues
  • Provide prior authorization medical reviews, consultation and clinical review services
  • Conduct clinical reviews for designated CareSource members
  • Identify utilization management trends and take appropriate action
  • Provide provider education, training, data sharing, performance evaluations and orientation to the plan
  • Support market provider network development and maintenance
  • Support staff by providing training, clinical consultation, and clinical case review for members
  • Support program design, development and innovation
  • Participate in peer-to-peer discussions
  • Participate in the development, implementation and revision of the Quality Improvement Plan and market level quality initiatives
  • Community collaborative participation
  • Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
  • Participate in development of policies and procedures
  • Provide cross-coverage for other Medical Directors and/or markets, as needed
  • Clinical Appeals Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
  • Perform any other job duties as requested

Requirements

  • 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 is required
  • Minimum of five (5) years of clinical practice experience in assigned area of specialty 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
  • Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required
  • Board Certification is required
  • Re-certification, as required by specialty board, must be maintained
  • 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