CareSource
Enterprise Medical Director page is loaded Enterprise Medical Director Apply locations Dayton WFH time type Full time posted on Posted 4 Days Ago job requisition id R9041
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 (hourly/salary): Salary
Organization Level 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.
#LI-SW2 About Us
The
CareSource mission
is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.
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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 (hourly/salary): Salary
Organization Level 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.
#LI-SW2 About Us
The
CareSource mission
is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.
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