Medical Director

CareSource

. Support staff through training, clinical consultation, and clinical case review for members .

Posted 9/17/2026full-timeRemote • United StatesLead💰 $195,200 - $341,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical review, quality improvement initiatives, and regulatory compliance, with a strong focus on provider education and member safety. Possesses a Doctor of Osteopathic Medicine (DO) or Medical Doctor (MD) degree, along with board certification and extensive clinical practice experience.

Highest-signal resume keywords

Doctor Of Osteopathic Medicine (DO)Medical Doctor (MD)Board Certification In Primary Care SpecialtyMCG CertificationClinical Practice Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewQuality Improvement InitiativesUtilization Data ReviewPolicy DevelopmentCase Management ActivitiesPerformance EvaluationsClinical Care Standards DevelopmentFraud InvestigationProvider EducationAccreditation Compliance

Soft Skills

Excellent Written And Oral Communication SkillsAbility To Work Independently And Within A TeamAttention To DetailDecision-Making And Problem-Solving SkillsConflict Resolution Skills

Tools & Technologies

Microsoft Word

Certifications & Qualifications

Current Unrestricted Medical LicenseMCG Certification

Industry Keywords

Managed CareClinical ConsultationQuality Of CareCMS ComplianceNCQA StandardsURAC ProgramsHealthcare AdministrationOperational ExcellencePrimary CareMedical Management

About the role

Key responsibilities & impact

Support staff through training, clinical consultation, and clinical case review for members
Provide clinical review services as directed
Participate in peer-to-peer discussions
Provide provider education, training, data sharing, performance evaluations, and orientation to the plan
Conduct clinical reviews for designated CareSource members
Provide physician review for clinical appeals cases
Participate in evaluation and investigation of suspected fraud, abuse, and quality-of-care concerns
Participate in development of policies and procedures
Participate in quality improvement initiatives, case management activities, and member safety activities
Provide cross-coverage for other Medical Directors and/or markets as needed
Oversee and support quality improvement activities associated with case management
Review utilization data to identify pattern variances and provide feedback and education to MCP staff and providers
Develop, implement, and revise clinical care standards and practice guidelines in compliance with nationally accepted quality standards
Develop, implement, and revise the Quality Improvement Plan and corporate-level quality initiatives
Collaborate with market/product leaders to help define market strategy
Participate in community collaboratives
Support regulatory and accreditation functions and compliance for CMS, State, NCQA, and URAC programs
Perform other job-related duties as requested
May work evenings/weekends
May sit or stand for extended periods in a general office environment

Requirements

What you’ll need

Doctor of Osteopathic Medicine (DO) required or Medical Doctor (MD) required
Successful completion of a residency training program, preferably in primary care, required
Five (5) years of clinical practice experience required
Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements required
Board Certification, preferably in primary care specialty required
Re-certification, as required by specialty board, must be maintained; exceptions may be granted by Chief Medical Officer
MCG Certification is required or must be obtained within six (6) months of hire
Basic Microsoft Word skills
Excellent written and oral communication skills
Ability to work 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 and problem-solving skills
Conflict resolution skills
Strong sense of mission and commitment to improving communities served
Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred
Managed care medical review/medical director experience preferred

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Substantial and comprehensive total rewards package
Up to 15% occasional travel to meetings, trainings, and conferences