Medical Director – Clinical Ops Case Review
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Job Description
Medical Director overseeing Clinical Operations at Medica health plan. Supporting various management areas including care management and quality initiatives.
Responsibilities:
- support care management, quality, utilization management, credentialing, pharmacy, health policy implementation, technology assessment and risk management activities
- Completes care management case review for cases involving medical necessity review
- Completes appeal case review for cases involving medical necessity review
- Partners to establish priorities as appropriate for improving service at the point of care
- Completes quality of care complaint reviews for cases involving clinical aspects or clinical/service aspects
- Participates in rotation to above Committee Participation
Requirements:
- Medical Doctorate (MD) or Doctor of Osteopathic Medicine (DO)
- 10+ years of experience beyond degree
- 5+ years of leadership experience
- Must be a licensed physician with current Board certification of ABMS recognized specialty
- Current medical license to practice must be without restrictions
- Must be willing and able to successfully apply for medical license in other states as needed
Benefits:
- competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees
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