Remote Medical Director - Grievances & Appeals

April 10

Apply Now

Receive Emails with Similar Jobs

CareSource

WebsiteLinkedInAll Job Openings

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

Medicaid • MyCare Ohio • Health Insurance Marketplace • Medicare Advantage • Health Insurance

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

📋 Description

• Medical Directors support CareSource staff by providing training, clinical consultation, and clinical case review for members. • Participate in peer-to-peer discussions. • Provide provider education, training, data sharing, performance evaluations and orientation to the plan. • Participate in evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns. • Provide prior authorization medical reviews, consultation and clinical review services. • Conduct clinical reviews for designated CareSource members.

🎯 Requirements

• 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, preferably in primary care is required. • Minimum of five (5) years of clinical practice experience is required. • 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

• In addition to base compensation, you may qualify for a bonus tied to company and individual performance. • Substantial and comprehensive total rewards package.