[Remote] Medical Director (REMOTE Appeals Medical Director - Pacific Standard Time, Managed Care Experience, Family Medicine, Internal Medicine-Pediatrics and Appeals Experience Preferred") - R11319

Note: The job is a remote job and is open to candidates in USA. CareSource is a managed care organization seeking a Medical Director to support staff through training, clinical consultation, and case reviews. The role involves providing prior authorization medical reviews, conducting clinical reviews, and participating in quality improvement initiatives.ResponsibilitiesProvide prior authorization medical reviews, consultation and clinical review servicesParticipate in peer-to-peer discussionsProvide provider education, training, data sharing, performance evaluations and orientation to the planConduct clinical reviews for designated CareSource members as requestedProvide physician review for clinical appeals casesParticipate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concernsParticipate in development of policies and proceduresParticipates in quality improvement initiatives, case management activities and member safety activities (i.e. incident management)Provide cross-coverage for other Medical Directors and/or markets, as neededOversight and quality improvement activities associated with case management activitiesAssist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriateParticipate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standardsParticipate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiativesCollaborate with market/product leaders to help define market strategyCommunity collaborative participationSupport of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programsPerform any other job related instructions, as requestedSkillsCompletion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is requiredSuccessful completion of a residency training program, preferably in primary care is requiredMinimum of five (5) years of clinical practice experience is requiredCurrent, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is requiredBoard Certification, preferably in primary care specialty is requiredRe-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer)MCG Certification is required or must be obtained within six (6) months of hireBasic Microsoft Word skillsExcellent communication skills, both written and oralAbility to work well independently and within a team environmentAbility to create strong relationships with Providers and MembersHigh ethical standardsAttention to detailCritical listening and systematic thinking skillsAbility to maintain confidentiality and act in the company's best interestAbility to act with diplomacy and sensitivity to cultural diversityDecision making/problem solving skillsConflict resolution skillsStrong sense of mission and commitment of time, effort and resources to the betterment of the communities servedManaged care medical review/medical director experience is preferredBachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferredBenefitsIn addition to base compensation, you may qualify for a bonus tied to company and individual performance.We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.Company OverviewCareSource provides managed care services to Medicaid beneficiaries. It was founded in 1989, and is headquartered in Dayton, Ohio, USA, with a workforce of 1001-5000 employees. Its website is https://www.caresource.com/.