Medical Director - LTSS

Responsibilities Responsible for utilization management across the Kansas Medicaid population, focusing on long-term services and supports (LTSS) Coordinates care and benefits, collaborating with internal teams, and engaging with external stakeholders such as the state and providers Supports clinicians to ensure timely and consistent responses to members and providers Provides guidance for clinical operational aspects of a program Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations May conduct peer-to-peer clinical appeal case reviews Serves as a resource and consultant for other areas of the company Interprets medical policies and clinical guidelines Develops and proposes new medical policies based on changes in healthcare Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes Identifies and develops opportunities for innovation to increase effectiveness and quality Requirements Requires MD or DO and Board certification approved by American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) Must possess an active unrestricted medical license to practice medicine or a health profession Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background For Health Solutions and Carelon organizations, minimum of 5 years of experience providing health care is required Preferred: Ability to obtain a Kansas medical license Preferred: Board certification in any Primary Care Specialty with Geriatrics experience Preferred: Five years of experience in directing health care services for frail elderly or individuals with physical, intellectual, and/or developmental disabilities #J-18808-Ljbffr Jobtailor