REMOTE - Market Medical Director(Must Have Michigan Licensure) - R12638

Job SummaryThe Market Medical Director is responsible for the implementation of market-level clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards.Essential FunctionsSupport staff by providing training, clinical consultation, and clinical case review for membersParticipate in Interdisciplinary Care Team meetings, Inpatient Census Rounds and other clinical meetingsSupport market provider network development and maintenanceProvides leadership to direct reports to achieve market goalsProvider education, training, data sharing, performance evaluations and orientation to the planParticipate in peer-to-peer discussionsParticipate in market level quality initiativesParticipate in community collaborativesParticipate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concernsProvide cross-coverage for other Medical Directors and/or markets, as neededUnderstand and provide support to prior authorization and utilization review functionsConduct quality of care reviewsSupport of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs Collaborates with the VP, Clinical Operations to identify utilization management and care management trends and take appropriate actionProvides consultation to the Market Operations teams regarding coding and reimbursement policiesServe as chair/co-chair of Market Committees as neededActs as designee for the VP, Market Chief Medical Officer as requiredPerform any other job duties as requestedEducation And ExperienceCompletion 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 requiredManaged care medical review/medical director experience is preferredBachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferredCompetencies, Knowledge And SkillsBasic 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 servedAbility to analyze healthcare data from a variety of sources to evaluate physician practice patternsLeadership experience and skillsLicensure And CertificationCurrent, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is requiredBoard Certification, preferably in primary care specialty is required; re-certification, as required by specialty board, must be maintainedTo help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.Working ConditionsGeneral office environment; may be required to sit or stand for extended periods of timeMay be required to work evenings/weekendsMay be required to travel to fulfill duties of positionCompensation Range$195,200.00 - $341,600.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In 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.Compensation TypeSalaryCompetencies Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.