Medical Director – Clinical Ops Case Review

Medica

Medical Director overseeing Clinical Operations at Medica health plan. Supporting various management areas including care management and quality initiatives.

Posted 7/8/2026full-timeRemote • Alabama, Arizona, Florida, Illinois, Iowa, Kansas, Kentucky, Minnesota, Missouri, Montana, New York, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Virginia, Wisconsin • 🇺🇸 United StatesLead💰 $235,600 - $319,770 per yearWebsite

About the role

Key responsibilities & impact

support care management, quality, utilization management, credentialing, pharmacy, health policy implementation, technology assessment and risk management activities
Completes care management case review for cases involving medical necessity review
Completes appeal case review for cases involving medical necessity review
Partners to establish priorities as appropriate for improving service at the point of care
Completes quality of care complaint reviews for cases involving clinical aspects or clinical/service aspects
Participates in rotation to above Committee Participation

Requirements

What you’ll need

Medical Doctorate (MD) or Doctor of Osteopathic Medicine (DO)
10+ years of experience beyond degree
5+ years of leadership experience
Must be a licensed physician with current Board certification of ABMS recognized specialty
Current medical license to practice must be without restrictions
Must be willing and able to successfully apply for medical license in other states as needed

Benefits

Comp & perks

competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Care ManagementQuality AssuranceUtilization ManagementMedical Necessity ReviewClinical Complaint Review

Soft Skills

CollaborationLeadership

Certifications

Board Certification of ABMS Recognized Specialty