Medical Director

About the role

The Medical Director will lead and participate in the Maryland Physicians Care MCO’s (MPCMCO) Medical Management Program. They will assist in the development and implementation of comprehensive medical policies and standards of care, provide leadership for the Health Management Teams, and be responsible for the general supervision of Utilization Management, Quality Management, and Inpatient Concurrent Review.

Responsibilities

• Participate in Quality Management and Utilization Management processes.
• Confer and consult with health professionals or providers with questions related to the concurrent review process.
• Conduct peer-to-peer clinical case reviews with attending physicians, physician advisors or other ordering providers to discuss review determinations.
• Provide medical support and direction to MPC MCO’s Pre-Authorization Unit related to the authorization of providers’ requests for elective consultations, procedures, tests, and formulary.
• Identify and report quality of care issues.
• Participate in MPC/MCO Grievance and Appeals Review Processes.
• Participate in the QM/UM Committee, the Pharmacy and Therapeutics Committee, and the Credentialing Committee as needed.
• Round with concurrent review nurses on a regular basis to discuss inpatient members as determined with MD.

Requirements

• Knowledge and familiarity of local, regional, and national provider medical standards of care.
• Ability to establish and maintain constructive relationships with diverse members, management, employees, and vendors.
• Ability to successfully utilize Microsoft Office Suite software applications and common computer and office hardware.
• Knowledge of Medicaid and Commercial regulatory requirements is beneficial.

Qualifications

• M.D. or D.O. unincumbered license with a minimum of five (5) years of post-residency clinical experience.
• Active Board certification.
• Experience in managed care practices, processes, procedures, and operations.
• Experience in utilization review and management practices, processes, and procedures.
• Knowledge and familiarity with contracts and policies as they pertain to the managed care environment.

Skills

Knowledge and familiarity of local, regional, and national provider medical standards of care.

Benefits

Competitive pay, excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%), 20 days of PTO, and tuition assistance/professional development plans.

Pay

$266,000 - $315,000

Schedule

Full-time