Medical Director/30/MCO005

TSS Medical Director (Ad Hoc / Backup Coverage) About The Role This ad hoc LTSS Medical Director position provides backup coverage when one of the primary LTSS Medical Directors is unavailable due to PTO, medical leave, or unforeseen circumstances. The physician will be trained in the LTSS case review process and serve as an on‑call clinical leader capable of stepping in as needed. Coverage is approximately 5 weeks per year, and the candidate must be willing to cover holidays. Pay Rate: $120-$125/hr Responsibilities Home & Community-Based Services Review — Conduct daily LTSS case reviews to approve or deny services based on medical necessity. Collaborate with nursing staff to clarify documentation.Board of Hearings Representation — Represent the health plan in Board of Hearing cases, presenting clinical rationale and supporting defensible determinations.Utilization Management — Monitor utilization trends and collaborate with Care Management, Health Services, and Behavioral Health to achieve UM goals.Integrated Clinical Collaboration — Support integrated clinical models across Behavioral Health and clinical operations.Clinical Quality & Peer Review — Participate in quality initiatives, peer review processes, and performance improvement projects.Cross-Functional Leadership — Partner with the CMO and clinical operations teams to support market and national clinical goals.Provider Communication — Serve as a clinical liaison to network physicians and community providers.Policy & Program Support — Assist in developing and implementing clinical policies, procedures, and improvement initiatives. Minimum Qualifications Active, unrestricted Massachusetts medical licenseBoard Certification in an ABMS or AOBMS specialty5+ years clinical practice experienceStrong knowledge of managed care and Medicaid LTSS2–3 years quality management experienceExcellent interpersonal and presentation skillsProven ability to build relationships with physicians and providersStrong project management and data interpretation skillsEffective negotiation and conflict management abilitiesProficiency with Microsoft Office Preferred Qualifications Experience with LTSS or home/community-based servicesPrior utilization management or medical director experienceExperience working in highly matrixed organizationsStrategic thinking with demonstrated ability to drive results Position Details Type: Ad hoc / backup coverageEstimated Coverage: ~5 weeks per yearHoliday Coverage: RequiredLocation: Massachusetts LTSS Programs (UnitedHealthcare Community Plan of MA)Reports To: Chief Medical Officer Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements. By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge's Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.