Medical Director (REMOTE Appeals Medical Director - Pacific Standard Time, Managed Care Experience/Appeals Experience Preferred")

REMOTEPosted 20 days ago

Job summary

• Job post source

  This job is directly from CareSource

• Job overview

  The Medical Director role at CareSource involves providing clinical consultation, training, and medical review to support managed care and appeals processes, impacting member care quality and compliance.

• Responsibilities and impact

  The Medical Director will conduct prior authorization reviews, participate in peer discussions, provide provider education, conduct clinical case reviews and appeals, support fraud and quality investigations, develop policies, engage in quality improvement and regulatory compliance, and collaborate with market leaders and community partners.

• Experience and skills

  Candidates must have an MD or DO degree, completed residency preferably in primary care, at least five years clinical experience, and preferably managed care and appeals experience; skills include strong communication, ethical standards, confidentiality, and decision-making abilities.

• Work environment and culture

  The role supports a mission-driven environment focused on community betterment, requiring collaboration, cultural sensitivity, and commitment to quality care.

• Company information

  CareSource is a healthcare company focused on managed care services, regulatory compliance, and quality improvement initiatives.

• Job location and travel

  This is a remote position aligned with Pacific Standard Time, with possible travel and occasional evening or weekend work.

• Unique job features

  The role requires MCG Certification within six months, board certification maintenance, and involves diverse clinical and regulatory responsibilities in a managed care setting.

Company overview

CareSource is a nonprofit managed care organization that provides public health care programs including Medicaid, Medicare, and Marketplace plans. Founded in 1989 and headquartered in Dayton, Ohio, CareSource focuses on offering accessible and affordable health care services to low-income individuals and families. The company generates revenue through government contracts and premiums from its various insurance plans. CareSource has grown significantly over the years, expanding its services to multiple states and continuously enhancing its programs to meet the evolving needs of its members.

How to land this job

• Tailor your resume to highlight your medical degree, board certification in primary care, and your clinical practice experience of at least five years, emphasizing any managed care and appeals experience to align with CareSource's preferred qualifications.

• Focus on showcasing skills in clinical consultation, prior authorization medical reviews, and peer-to-peer discussions, as these are core responsibilities of the Medical Director role at CareSource.

• Apply through multiple channels including CareSource's official corporate careers page and LinkedIn to maximize your application visibility.

• Connect with current Medical Directors or clinical leadership within CareSource on LinkedIn; start conversations by referencing recent quality improvement initiatives at CareSource or asking about their experience with appeals processes to break the ice.

• Optimize your resume for ATS by incorporating keywords from the job description such as 'managed care,' 'appeals,' 'clinical review,' 'quality improvement,' and 'MCG Certification' to ensure your resume passes automated screenings.

• Utilize Jennie Johnson's Power Apply feature to automate tailored applications across multiple job boards and LinkedIn, while also identifying relevant CareSource contacts for networking, allowing you to focus your time on preparing for interviews and enhancing your qualifications.