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

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive experience in care management, quality assurance, and utilization management, with a strong focus on medical necessity reviews and clinical complaint assessments. Holds a current medical license and board certification, ensuring compliance with healthcare standards and regulations.

Highest-signal resume keywords

Medical Doctorate (MD) or Doctor of Osteopathic Medicine (DO)10+ Years of Experience Beyond Degree5+ Years of Leadership ExperienceCurrent Board Certification of ABMS Recognized SpecialtyLicensed Physician with Current Medical License

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care ManagementQuality AssuranceUtilization ManagementMedical Necessity ReviewClinical Complaint Review

Soft Skills

CollaborationLeadership

Certifications & Qualifications

Board Certification of ABMS Recognized Specialty

Industry Keywords

CredentialingPharmacyHealth Policy ImplementationTechnology AssessmentRisk Management

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