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CareSource · 2 days ago

Medical Director, Ohio Market(Geriatrics, Internal Medicine, Family Practice Preferred) - R10269

Ohio, United States

Full-time

Onsite

Mid, Senior Level

$195K/yr - $342K/yr

5+ years exp

CareSource is a healthcare organization focused on providing quality services. The Medical Director, Ohio Market is responsible for developing and implementing clinical care standards and practice guidelines while ensuring compliance with quality standards.

Health CareMedicalNon Profit

Comp. & Benefits

H1B Sponsor Likely

Responsibilities

Collaborate with market/product leaders to help define market strategy

Represent CareSource at state and regulatory venues

Provide prior authorization medical reviews, consultation and clinical review services

Conduct clinical reviews for designated CareSource members

Identify utilization management trends and take appropriate action

Provide provider education, training, data sharing, performance evaluations and orientation to the plan

Support market provider network development and maintenance

Support staff by providing training, clinical consultation, and clinical case review for members

Support program design, development and innovation

Participate in peer-to-peer discussions

Participate in the development, implementation and revision of the Quality Improvement Plan and market level quality initiatives

Community collaborative participation

Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns

Participate in development of policies and procedures

Provide cross-coverage for other Medical Directors and/or markets, as needed

Clinical Appeals

Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs

Perform any other job duties as requested

Qualification

Medical Degree (MD/DO)Board CertificationClinical practice experienceManaged care experienceHealthcare data analysisMicrosoft WordCritical listeningCommunication skillsTeamworkRelationship buildingAttention to detailDecision makingConflict resolutionLeadership skills

Required

Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required

Successful completion of a residency training program is required

Minimum of five (5) years of clinical practice experience in assigned area of specialty is required

Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required

Board Certification is required

Re-certification, as required by specialty board, must be maintained

Basic Microsoft Word skills

Excellent communication skills, both written and oral

Ability to work well independently and within a team environment

Ability to create strong relationships with Providers and Members

High ethical standards

Attention to detail

Critical listening and systematic thinking skills

Ability to maintain confidentiality and act in the company's best interest

Ability to act with diplomacy and sensitivity to cultural diversity

Decision making/problem solving skills

Conflict resolution skills

Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served

Ability to analyze healthcare data from a variety of sources to evaluate physician practice patterns

Leadership experience and skills

Preferred

Managed care medical review/medical director experience is preferred

Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred

Benefits

A bonus tied to company and individual performance

Substantial and comprehensive total rewards package

Company

CareSource

Glassdoor3.8

CareSource provides managed care services to Medicaid beneficiaries.

Founded in 1989

Dayton, Ohio, USA

1001-5000 employees

https://www.caresource.com/

H1B Sponsorship

CareSource has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (30)

2024 (39)

2023 (35)

2022 (21)

2021 (37)

2020 (28)