LTSS Medical Director - Kansas Medicaid

About the role

This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Responsibilities

• Supports clinicians to ensure timely and consistent responses to members and providers.
• Provides guidance for clinical operational aspects of a program.
• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
• Serves as a resource and consultant for other areas of the company.
• May be required to represent the company to external entities and/or serve on internal and/or external committees.
• May chair company committees.
• Interprets medical policies and clinical guidelines.
• May develop and propose new medical policies based on changes in healthcare.
• Led, develops, directs, and implements clinical and non-clinical activities that impact health care quality, cost, and outcomes.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.

Requirements

• Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
• Must possess an active unrestricted medical license to practice medicine or a health profession.
• Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
• Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
• Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.

Qualifications

• Ability to obtain a Kansas medical license.
• Board certification in any Primary Care Specialty with Geriatrics experience is strongly preferred.
• Five years of experience in directing health care services for frail elderly or individuals of any age with physical, intellectual, and/or developmental disabilities strongly preferred.

Skills

• Strong clinical expertise.
• Excellent communication and interpersonal skills.
• Ability to manage multiple tasks and prioritize responsibilities.
• Experience in healthcare utilization management.
• Knowledge of medical policies and guidelines.
• Leadership and team management skills.

Benefits

• Market-competitive total rewards package.
• Medical, dental, and vision insurance.
• Short and long-term disability benefits.
• 401(k) match.
• Stock purchase plan.
• Life insurance.
• Wellness programs and financial education resources.

Pay

The pay for this role is commensurate with experience.

Schedule

The LTSS Medical Director works virtually full-time, with the exception of required in-person training sessions.