Medical Director, Ohio Market(Geriatrics, Internal Medicine, Family Practice Preferred)

Job Summary :

The Medical Director, Ohio Market is responsible for participating in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards.

Essential Functions :

• Collaborate with market / product leaders to help define market strategy
• Represent CareSource at state and regulatory venues
• Provide prior authorization medical reviews, consultation and clinical review services
• Conduct clinical reviews for designated CareSource members
• Identify utilization management trends and take appropriate action
• Provide provider education, training, data sharing, performance evaluations and orientation to the plan
• Support market provider network development and maintenance
• Support staff by providing training, clinical consultation, and clinical case review for members
• Support program design, development and innovation
• Participate in peer-to-peer discussions
• Participate in the development, implementation and revision of the Quality Improvement Plan and market level quality initiatives
• Community collaborative participation
• Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
• Participate in development of policies and procedures
• Provide cross-coverage for other Medical Directors and / or markets, as needed
• Clinical Appeals
• Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
• Perform any other job duties as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range :

$191,400.00 - $334,900.00 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 Type : Salary

Competencies :

This 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 inclusive environment that welcomes and supports individuals of all backgrounds.

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