Market Chief Medical Director(Must Live In Michigan)

CareSource

1d•Onsite

About The Position

The Market Medical Director is responsible for the implementation of market-level clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards. This role involves supporting staff through training and clinical consultation, participating in various clinical meetings, and contributing to provider network development. The position also requires leadership of direct reports, provider education, and participation in quality initiatives and case reviews for fraud, abuse, and quality of care concerns. Additionally, the role supports prior authorization, utilization review, regulatory compliance, and collaborates with leadership on utilization and care management trends. Consultation on coding and reimbursement, chairing committees, and acting as a designee for higher-level management are also key aspects of the role.

Requirements

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
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
Influenza vaccination is a requirement of this position.
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

Nice To Haves

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

Responsibilities

Support staff by providing training, clinical consultation, and clinical case review for members
Participate in Interdisciplinary Care Team meetings, Inpatient Census Rounds and other clinical meetings
Support market provider network development and maintenance
Provides leadership to direct reports to achieve market goals
Provider education, training, data sharing, performance evaluations and orientation to the plan
Participate in peer-to-peer discussions
Participate in market level quality initiatives
Participate in community collaboratives
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
Understand and provide support to prior authorization and utilization review functions
Conduct quality of care reviews
Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
Collaborates with the VP, Clinical Operations to identify utilization management and care management trends and take appropriate action
Provides consultation to the Market Operations teams regarding coding and reimbursement policies
Serve as chair/co-chair of Market Committees as needed
Acts as designee for the VP, Market Chief Medical Officer as required
Perform any other job duties as requested