Medical Director

Title: Medical Director

Shift timings: 8-5 EST M-F

Duration: 12 months

Location: The role is 100% remote, but candidates need to be from an approved conversion State (Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.)

JOB DESCRIPTION

The application of a Medical Director’s knowledge and clinical skills will vary across the Health Care division, dependent on focus areas identified by the business area supported.

Leadership Skills:

• Project planning and management

Core Skills:

• Strategy
• Develops, collaborates and/or drives strategy and approach for varied Health Care and/or organizational initiatives (i.e. sales management strategies, behavioral health strategies, new health care delivery strategies)
• Operations
• Medical reimbursement and policy
• Care management (utilization management, case management, PA, appeals)
• Healthcare programs (disease management, Moonshots)
• Network support (Credentialing)
• Quality model design and analysis
• Partnership
• Develop strategic partnerships with internal business partners and external clients to support value based agreements and drive better consumer and provider experience.
• Takes a lead role in outreach and relationship building across the community (i.e. providers, health systems, community partners, members, etc).
• Evaluate and manage new and/or existing vendors and solution partners to align to strategic direction
• Ongoing provider engagement functions
• Data gathering, management and analysis
• Evaluate clinical and other data to identify opportunities for improvement in health outcomes and financial performance
• Discuss data and performance with providers, employers, accreditors and regulators as needed.
• Communications
• Represent through delivery of presentations, speaking engagements and leadership of advisory groups with external audiences related to health care transformation and initiatives.
• Publish high impact content focused on improving accessibility, quality and affordability.
• Innovation
• Payment model design
• Identify market trends that should influence key investments (new technologies, best practices).
• Evaluation of investment/partnership opportunities

Hiring Requirements

• MD or DO from an accredited medical school and completion of residency training program.
• 7+ years of experience in related field
• Some relevant experience outside of clinical practice is also required
• Current North Carolina medical license
• Board certification in ABMS/AOA recognized clinical specialty is required

Top 3-4 Required Skills: Utilization management experience, needs to be in the weeds, NC License

Tech Savy Excperience in government and commerical markets,

Years of Experience: 7+ years

Education/Certifications Required: MD or DO from accredited medical school

Industry Specific Experience – required, ideal, necessary? Healthcare Insurance

Breakdown of Duties/Typical Day: Transactional work, would be responsible for all lines of business, Commercial, MA, FEP, and Appeals. Would cover call on the weekend (minumal could be once a month) Peer to Peer - call providers and have a discussion on any denials.

Screening Question:

How many cases have you typically reviewed in a day?

Applicant Notices & Disclaimers

• For information on benefits, equal opportunity employment, and location-specific applicant notices

Requirements added by the job poster

• 8+ years of work experience with Utilization Management

• 8+ years of work experience with Health Insurance