Carbon Health is looking for a Medical Director to join our team. You will assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions. This hybrid role provides medical leadership for utilization management, cost containment, and quality improvement activities.
What You'll Do
- Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
- Perform medical review activities pertaining to utilization review, quality assurance, and review of complex, controversial, or experimental medical services.
- Support effective implementation of performance improvement initiatives for capitated providers.
- Assist the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service.
- Provide medical expertise in the operation of approved quality improvement and utilization management programs.
- Assist the Chief Medical Director in the functioning of physician committees.
- Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams.
- Collaborate effectively with clinical teams, network providers, appeals team, and consultants for reviewing complex cases and appeals.
- Participate in provider network development and new market expansion as appropriate.
- Assist in the development and implementation of physician education.
- Identify utilization review studies and evaluate adverse trends.
- Identify clinical quality improvement studies to reduce unwarranted variation in clinical practice.
- Interface with physicians and providers to facilitate implementation of recommendations.
- Review claims involving complex, controversial, unusual, or new services to determine medical necessity and payment.
- Develop alliances with the provider community through medical management programs.
- May represent the business unit before various publics on medical philosophy and policies.
- Represent the business unit at appropriate state committees and other ad hoc committees.
- May be required to work weekends and holidays in support of business operations.
What We're Looking For
- Medical Doctor or Doctor of Osteopathy degree.
- Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services.
- Current state license (Kansas, Ohio, Michigan, Wisconsin, Illinois, Nebraska, Iowa, Missouri, Pennsylvania, Indiana preferred) as a MD or DO without restrictions, limitations, or sanctions from government programs.
- Active practice of medicine.
Nice to Have
- Utilization Management experience.
- Knowledge of quality accreditation standards.
- Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management.
- Experience treating or managing care for a culturally diverse population.
Team & Environment
You will report directly to the Chief Medical Director and assist them in their duties.
Benefits & Compensation
- Compensation range: $221,300.00 - $420,500.00 per year.
- Health insurance.
- 401K and stock purchase plans.
- Tuition reimbursement.
- Paid time off plus holidays.
- Flexible approach to work with remote, hybrid, field or office work schedules.
Work Mode
This is a hybrid position with locations in Missouri, Ohio, and Kansas.
Carbon Health is committed to diversity and values the ways in which we are different. We are an equal opportunity employer.
