CareSource
Join to apply for the
Enterprise Medical Director - R9041
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CareSource 2 days ago Be among the first 25 applicants Join to apply for the
Enterprise Medical Director - R9041
role at
CareSource Get AI-powered advice on this job and more exclusive features. Job Summary
The Enterprise Medical Director is responsible for the development, implementation and revision of corporate level clinical care standards and practice guidelines, ensuring compliance with nationally accepted quality standards. Job Summary
The Enterprise Medical Director is responsible for the development, implementation and revision of corporate level clinical care standards and practice guidelines, ensuring compliance with nationally accepted quality standards.
Essential Functions
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 Clinical Appeals 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
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 MCG Certification is required or must be obtained within six (6) months of hire
Working Conditions
General office environment; may be required to sit or stand for extended periods of time May be required to work evenings/weekends Ability to travel as required by the needs of the business
Compensation Range
$191,400.00 - $334,900.00 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
Salary
Competencies
Create an Inclusive Environment - 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 inclusive environment that welcomes and supports individuals of all backgrounds.
Seniority level
Seniority level Director Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Insurance Referrals increase your chances of interviewing at CareSource by 2x Get notified about new Medical Director jobs in
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Enterprise Medical Director - R9041
role at
CareSource 2 days ago Be among the first 25 applicants Join to apply for the
Enterprise Medical Director - R9041
role at
CareSource Get AI-powered advice on this job and more exclusive features. Job Summary
The Enterprise Medical Director is responsible for the development, implementation and revision of corporate level clinical care standards and practice guidelines, ensuring compliance with nationally accepted quality standards. Job Summary
The Enterprise Medical Director is responsible for the development, implementation and revision of corporate level clinical care standards and practice guidelines, ensuring compliance with nationally accepted quality standards.
Essential Functions
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 Clinical Appeals 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
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 MCG Certification is required or must be obtained within six (6) months of hire
Working Conditions
General office environment; may be required to sit or stand for extended periods of time May be required to work evenings/weekends Ability to travel as required by the needs of the business
Compensation Range
$191,400.00 - $334,900.00 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
Salary
Competencies
Create an Inclusive Environment - 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 inclusive environment that welcomes and supports individuals of all backgrounds.
Seniority level
Seniority level Director Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Insurance Referrals increase your chances of interviewing at CareSource by 2x Get notified about new Medical Director jobs in
Dayton, OH . Clinical Director- Cincinnati/ Dayton RRP
Dayton, OH $85,000.00-$95,000.00 2 weeks ago Respiratory Manager - Respiratory Care - Full Time
ORTHOPEDICS - MEDICAL PRACTICE MANAGER III
Medical Director- Emergency Veterinarian | Dayton, OH
Chief Medical Information Officer (CMIO)
Dayton, OH $90,000.00-$150,000.00 4 days ago Bilingual Mandarin Supervisor in Training
Dayton, OH $80,000.00-$89,000.00 1 day ago Center Manager - Durable Medical Equipment (DME)
Associate Medical Director/Medical Director - Transfusion Medicine
Manager-Medical Imaging-Miami Valley South
Wound Care Nurse Practitioner (NP) / Physician Assistant (PA)
Dayton, OH $174,070.00-$374,920.00 3 days ago Nurse Practitioner - Advanced Illness Management
Dayton, OH $96,390.00-$125,490.00 2 days ago Nurse Practitioner - Advanced Illness Management
Dayton, OH $96,390.00-$125,490.00 3 days ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr