Enterprise Medical Director

CareSource

Enterprise Medical Director leading clinical care standards development and implementation at CareSource. Ensuring compliance with national quality standards and supporting medical leadership in operational roles.

Posted 6/10/2026full-timeRemote • 🇺🇸 United StatesLead💰 $195,200 - $341,600 per yearWebsite

About the role

Key responsibilities & impact

Development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
Development of policies and procedures
Medical Director Operational leadership, Medical Economics Analytics
Identify utilization management trends and take appropriate action
Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
Support staff by providing training, clinical consultation, and clinical case review for members
Participate in peer-to-peer discussions
Provide provider education, training, data sharing, performance evaluations and orientation to the plan
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
Provide prior authorization medical reviews, consultation and clinical review services
Conduct clinical reviews for designated CareSource members
Collaborate with market/product leaders to help define market strategy
Provides oversight and direction of assigned managers and associates
Perform any other job duties as requested

Requirements

What you’ll need

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
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
MCG Certification is required or must be obtained within six (6) months of hire

Benefits

Comp & perks

substantial and comprehensive total rewards package

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Quality Improvement Plan developmentMedical Economics AnalyticsUtilization managementPrior authorization medical reviewsClinical review servicesClinical consultationFraud investigationData sharingPerformance evaluationsPolicy and procedure development

Soft Skills

Operational leadershipTrainingCollaborationOversightCommunicationClinical case reviewProvider educationPeer-to-peer discussionsMarket strategy definitionSupport staff

Certifications

Medical Degree (MD or DO)Board Certification in primary care specialtyMCG Certification