Medical Director
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Job Description
Medical Director evaluating healthcare services for Medicare and Medicaid compliance within a caring community. Leading a collaborative team to ensure regulatory compliance and exceptional consumer experiences.
Responsibilities:
- Review clinical cases and determine medical necessity of services for Medicare and Medicaid members
- Ensure compliance with review policies, procedures, and regulatory standards
- Apply clinical guidelines, CMS policies, and Medicare/Medicare Advantage/Medicaid requirements
- Identify opportunities for medical management operational improvements
- Participate in call rotations, including weekend coverage and after-hours coverage
- Contribute to an engaged, collaborative team culture that supports organizational excellence
- Deliver exceptional consumer experiences
- Support Home Solutions and other activities as assigned by the OneHome leadership
Requirements:
- MD or DO degree
- Current, active and ongoing board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialties (AOABPS). National Board of Physicians & Surgeons (NBPAS) certification is not accepted
- Current and unrestricted state license in at least one state and willing to obtain other medical licenses, as required, for various states in region of assignment
- No sanctions from Federal or State Governmental organizations
- 10 years of direct clinical patient care experience post residency or fellowship
- The ability to pass credentialing requirements
- Intermediate to advanced skills utilizing Microsoft Office and Internet navigation
- Strong verbal and written communication skills, with the ability to analyze information and interpret data clearly and accurately
- Adaptable and willing to learn new technologies to enhance workflow efficiency
- Participate in educational activities by attending required conferences and creating content to present for individual subject matter contribution
Benefits:
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
- many other opportunities
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