Remote Medical Director, Inpatient Marketplace
Core
Provide medical leadership for utilization management, cost containment, and quality improvement activities for a capitated provider network.
Role type
Senior Medical Director (Inpatient Marketplace)
Builds
Utilization management programs, quality improvement initiatives, and provider network strategies.
Domain
Healthcare administration and insurance
Required skills
Medical leadership, utilization management, quality improvement, regulatory compliance, provider network development, claims review, clinical quality studies, physician education, stakeholder management, committee management.
Preferred skills
Health administration/financing knowledge, experience with diverse populations, Internal or Family Medicine board certification.
Technologies
None stated
Responsibilities
Direct medical management and credentialing functions; perform medical reviews for complex cases; conduct rounds for high-risk patients; collaborate on appeals and medical necessity determinations; develop alliances with the provider community; represent the business unit at state committees; identify and evaluate adverse utilization trends.
Seniority
Senior, hands-on IC