Enterprise Medical Director-Perinatal Health(Need to Live in Mississippi)

Job Summary:The Enterprise Medical Director is responsible for the development, implementation and revision of corporate level clinical care standards and practice guidelines, ensuring compliance with nationally accepted quality standards.Essential Functions:Development, implementation and revision of the Quality Improvement Plan and corporate level quality initiativesDevelopment of policies and proceduresMedical Director Operational leadership, Medical Economics AnalyticsIdentify utilization management trends and take appropriate actionSupport of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programsSupport staff by providing training, clinical consultation, and clinical case review for membersParticipate in peer-to-peer discussionsProvide provider education, training, data sharing, performance evaluations and orientation to the planParticipate 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 neededProvide prior authorization medical reviews, consultation and clinical review servicesConduct clinical reviews for designated CareSource membersClinical AppealsCollaborate with market/product leaders to help define market strategyProvides oversight and direction of assigned managers and associatesPerform any other job duties as requestedEducation and Experience:Completion 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 Skills:Basic 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 Certification:Current, 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 maintainedMCG Certification is required or must be obtained within six (6) months of hireWorking Conditions:General office environment; may be required to sit or stand for extended periods of timeMay be required to work evenings/weekendsAbility to travel as required by the needs of the businessCompensation Range:$168,840.00 - $295,470.00 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. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.Compensation Type:SalaryThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.

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