Medical Director
About The Position
The Medical Director administers medical services to ensure members receive appropriate and cost-effective care. The role may develop and implement programs to improve quality, cost, and outcomes; provide clinical consultation and strategic advice to enhance clinical operations; identify cost-of-care opportunities; support staff, including Medical Director Associates; and oversee an entire clinical program. This is a primarily virtual, full-time position, with required in-person training sessions. The ideal location is in the Mountain Time Zone, though candidates in other time zones may be considered. Candidates must be within reasonable commuting distance of a posting location unless an accommodation is granted as required by law. Evening and weekend coverage is shared on an equal rotation.
Requirements
- MD or DO degree.
- Board certification, where applicable to duties performed, from a certifying board approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).
- Active, unrestricted medical or health-profession license.
- When conducting utilization review or appeals consideration, must be located in a U.S. state or territory, unless expressly allowed otherwise by state or federal law or regulation; cannot be located on a U.S. military base, vessel, or embassy in or outside the United States.
- At least 10 years of clinical experience, or an equivalent combination of education and experience.
Nice To Haves
- Additional state licensing, or willingness to obtain it.
- Previous experience in utilization management.
- Experience with MCG, Carelon, and Anthem criteria.
- Oncology or genetic testing specialty review experience.
- Musculoskeletal review experience.
Responsibilities
- Support clinicians in providing timely and consistent responses to members and providers.
- Provide guidance on clinical operational aspects of a program.
- Conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patients’ office visits.
- Serve as a resource and consultant to other company areas.
- Represent the company to external entities and serve on internal and external committees.
- Chair company committees.
- Interpret medical policies and clinical guidelines.
- Develop and propose new medical policies in response to changes in healthcare.
- Lead, develop, direct, and implement clinical and non-clinical activities that affect healthcare quality, cost, and outcomes.
- Identify and develop opportunities for innovation to increase effectiveness and quality.
- Provide evening and weekend coverage on an equal rotation.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase.
- 401(k) contribution.
- Merit increases.
- Paid holidays.
- Paid Time Off.
- Incentive bonus programs, unless covered by a collective bargaining agreement.
- Medical insurance.
- Dental insurance.
- Vision insurance.
- Short- and long-term disability benefits.
- 401(k) match.
- Stock purchase plan.
- Life insurance.
- Wellness programs.
- Financial education resources.
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What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
Ph.D. or professional degree
