Medical Director @CareSource Management Services LLC

[Hiring] Medical Director @CareSource Management Services LLC

Apr 13, 2025 - CareSource Management Services LLC is hiring a remote Medical Director. 💸 Salary: $191,400 - $334,900. 📍Location: USA.

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Role Description

Medical Directors support CareSource staff by providing training, clinical consultation, and clinical case review for members.

Support staff by providing training, clinical consultation, and clinical case review for members
Participate in peer-to-peer discussions
Provide provider education, training, data sharing, performance evaluations and orientation to the plan
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
Provide prior authorization medical reviews, consultation and clinical review services
Conduct clinical reviews for designated CareSource members
Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs
Managed care medical review/medical director experience is required
Managed care appeals determinations experience with multiple lines of business (e.g. Medicaid, Medicare, Marketplace) is required
Perform any other job duties as requested

Qualifications

Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required
Successful completion of a residency training program, preferably in primary care is required
Minimum of five (5) years of clinical practice experience is required
Managed care medical review/medical director experience is preferred
Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred

Competencies, Knowledge and Skills

Basic Microsoft Word skills
Excellent communication skills, both written and oral
Ability to work well independently and within a team environment
Ability to create strong relationships with Providers and Members
High ethical standards
Attention to detail
Critical listening and systematic thinking skills
Ability to maintain confidentiality and act in the company’s best interest
Ability to act with diplomacy and sensitivity to cultural diversity
Decision making/problem solving skills
Conflict resolution skills
Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served

Licensure and Certification

Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required
Board Certification, preferably in primary care specialty is required; re-certification, as required by specialty board, must be maintained

Working Conditions

General office environment; may be required to sit or stand for extended periods of time
May be required to work evenings/weekends
Ability to travel as required by the needs of the business

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.

Organization Level Competencies

Create an Inclusive Environment
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business

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📍	Be aware of the location restriction for this remote position: USA
‼	Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more.

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Medical Director @CareSource Management Services LLC

All others

Salary 💸 $191,400 - $334,900	Remote Location USA
Job Type full-time	Posted Apr 13, 2025

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📍	Be aware of the location restriction for this remote position: USA
‼	Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more.

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[Hiring] Medical Director @CareSource Management Services LLC

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