CareBridge-posted 2 months ago
Full-time • Senior
Ashtabula, OH
251-500 employees
Ambulatory Health Care Services

The Medical Director - Long Term Support and Services is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. This role may involve developing and implementing programs to improve quality, cost, and outcomes, providing clinical consultation, and serving as a clinical/strategic advisor to enhance clinical operations. The position may also identify cost of care opportunities and serve as a resource to staff including Medical Director Associates. The Medical Director may be responsible for an entire clinical program.

  • Supports clinicians to ensure timely and consistent responses to members and providers.
  • Provides guidance for clinical operational aspects of a program.
  • Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations.
  • May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers.
  • Serves as a resource and consultant for other areas of the company.
  • May be required to represent the company to external entities and/or serve on internal and/or external committees.
  • May chair company committees.
  • Interprets medical policies and clinical guidelines.
  • May develop and propose new medical policies based on changes in healthcare.
  • Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
  • Identifies and develops opportunities for innovation to increase effectiveness and quality.
  • Requires MD or DO and Board certification approved by one of the following certifying boards: American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
  • Must possess an active unrestricted medical license to practice medicine or a health profession.
  • A minimum of 10 years of clinical experience; or any combination of education and experience that would provide an equivalent background.
  • For Health Solutions and Carelon organizations (including behavioral health), a minimum of 5 years of experience providing health care is required.
  • Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
  • 1-2 years Utilization Management experience strongly preferred.
  • Strong oral, written, and interpersonal communication skills.
  • Problem-solving skills, facilitation skills, and analytical skills.
  • Merit increases
  • Paid holidays
  • Paid Time Off
  • Incentive bonus programs
  • Medical, dental, vision benefits
  • Short and long term disability benefits
  • 401(k) + match
  • Stock purchase plan
  • Life insurance
  • Wellness programs
  • Financial education resources
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