Medical Director
Core
Provide clinical consultation, prior authorization reviews, and case management oversight for CareSource members.
Role type
Senior clinical medical director (managed care)
Builds
Clinical care standards, quality improvement plans, and member safety initiatives
Domain
Healthcare administration and managed care
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
clinical case review, prior authorization, fraud investigation, policy development, quality improvement, regulatory compliance, data analysis
Preferred skills
managed care medical review experience, healthcare administration degree
Technologies
Microsoft Word
Responsibilities
Conduct clinical reviews for designated members, participate in peer-to-peer discussions, evaluate cases suspected of fraud, develop clinical care standards, support regulatory accreditation functions, collaborate on market strategy
Seniority
Senior, hands-on IC