Remote Medical Director, Pharmacy
Core
Provide medical leadership for utilization management, cost containment, and quality improvement activities for a health insurance business unit.
Role type
Senior Medical Director (Pharmacy/Utilization Management)
Builds
Medical management programs, provider networks, and quality improvement initiatives for capitated providers.
Domain
Health Insurance / Utilization Management / Quality Improvement
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Utilization management, medical review of complex cases, provider network development, clinical quality improvement studies, claims adjudication for medical necessity, physician education, regulatory compliance, committee management
Preferred skills
Health administration, health financing, insurance, personnel management, experience with culturally diverse populations, Internal or Family Medicine certification
Technologies
None stated
Responsibilities
Direct and coordinate medical management and credentialing functions, perform medical reviews for utilization and quality assurance, conduct rounds for high-risk patients, collaborate on complex case appeals, develop provider alliances, represent the business unit at state committees, evaluate adverse trends in utilization
Seniority
Senior, hands-on IC with strategic oversight
