Market Medical Director(Must Have Michigan Licensure)

Job Summary The 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 Functions Support staff by providing training, clinical consultation, and clinical case review for members Participate in Interdisciplinary Care Team meetings, Inpatient Census Rounds, and other clinical meetings Support market provider network development and maintenance Provide leadership to direct reports to achieve market goals Provider education, training, data sharing, performance evaluations and orientation to the plan Participate in peer-to-peer discussions Participate in market level quality initiatives Participate in community collaboratives Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns Provide cross-coverage for other Medical Directors and/or markets, as needed Understand and provide support to prior authorization and utilization review functions Conduct quality of care reviews Support of regulatory and accreditation functions (e.g., CMS, State, NCQA, URAC) and compliance for all programs Collaborate with the VP, Clinical Operations to identify utilization management and care management trends and take appropriate action Provide consultation to the Market Operations teams regarding coding and reimbursement policies Serve as chair/co-chair of Market Committees as needed Act as designee for the VP, Market Chief Medical Officer as required Perform any other job duties as requested Education and Experience Completion of an accredited Medical Degree program as an MD or DO (required) Successful completion of residency training program, preferably in primary care (required) Minimum of five (5) years of clinical practice experience (required) Managed care medical review/medical director experience preferred Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management preferred Competencies, Knowledge and Skills Basic Microsoft Word skills Excellent communication skills, both written and oral Ability to work well independently and within a team environment Ability to create strong relationships with Providers and Members High ethical standards Attention to detail Critical listening and systematic thinking skills Ability to maintain confidentiality and act in the company’s best interest Ability to act with diplomacy and sensitivity to cultural diversity Decision‑making/problem‑solving skills Conflict resolution skills Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served Ability to analyze healthcare data from a variety of sources to evaluate physician practice patterns Leadership experience and skills Licensure and Certification Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements (required) Board Certification, preferably in primary care specialty, required; re‑certification as required by specialty board must be maintained Influenza Vaccination Requirement To 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 (October1–March31) 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. Working Conditions General office environment; may be required to sit or stand for extended periods of time May be required to work evenings/weekends May be required to travel to fulfill duties of position Compensation Range $195,200.00–$341,600.00 (subject to additional bonus opportunities). Basis for compensation includes education, training, experience, and level of responsibility. Equal Opportunity Statement CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #J-18808-Ljbffr