Associate Medical Director

Associate Medical Director

The CommuniCare Family of Companies currently owns / operates more than 85 Nursing and Rehabilitation Centers, Specialty Care Centers and Assisted Living Communities in 7 states. Since 1984, CommuniCare Health Services has provided superior, comprehensive management services for the development and management of adult living communities.

Due to growth, we are seeking an experienced Associate Medical Director.

The position of part-time Associate Medical Director is responsible for supporting the Medicare Advantage Plans clinical and quality activities and operations at the direction of the Chief Medical Officer approximately 25 hours per week. This position reports directly to the Chief Medical Officer, Medicare Advantage Plans.

Job duties & responsibilities may include the following and will be finalized based on the skills and interests of the successful candidate :

• Medical Management
• Support strategies and interventions to improve quality outcomes, medical expense trends, and STARS ratings
• Health Care Services Management
• Conduct prior authorization and utilization management activities including adverse determinations.
• Collaborate with consultant physicians as necessary to review selected authorization requests or appeals of adverse determinations.
• Support processes relating to performance and audit of vendors or provider organizations delegated for UM.
• Lead review and submission of clinical practice guidelines, utilization and concurrent review criteria, and other similar guidelines to Medical Policy or applicable committees.
• Participate in Plan committees such as  Medical Policy, Credentialing, Quality Improvement, Peer Review and others as assigned.
• Collaborate with medical directors and other clinical leaders from across the contracted network including CHS affiliates as on assigned projects .
• Support care innovations across the enterprise

Support the implementation and execution of the Quality Assurance Plan including but not limited to :

Qualifications & Experience requirements