supports clinicians to ensure timely and consistent responses to members and providers
guides clinical operational aspects of a program
conducts peer-to-peer clinical reviews with attending physicians or other providers
serves as a resource and consultant to 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/DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, 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
Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background
Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency
Utilization Management experience is a plus
Ability to meet necessary internet speed requirements and adhere to work-at-home agreements
Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills

Medical Director

Key skills