Medical Director: Clinical Quality & Strategy

CareSource; Northern (KY); Hybrid; USD 195,000 - 342,000; Full time

Job summary

CareSource is seeking a Medical Director to lead clinical review activities, provide education to providers, and support quality and regulatory initiatives across markets. The role emphasizes oversight of case management, data-driven improvements, and collaboration with market leadership.

The position requires DO or MD, board certification, residency in primary care, and a minimum of five years of clinical practice, with managed care experience preferred. Occasional travel may be involved.

Qualifications

• DO or MD required to practice medicine.
• Residency in primary care preferred.
• Five years of clinical practice experience required.
• Current, unrestricted medical license in state of practice.
• Board Certification in primary care preferred.
• MCG Certification required within six months of hire.
• Managed care medical review experience preferred.

Responsibilities

• Provide clinical review services as directed.
• Participate in peer-to-peer discussions.
• Educate providers, training, data sharing, and performance evaluations.
• Review designated CareSource member cases.
• Provide physician review for clinical appeals cases.
• Investigate fraud, abuse, and quality of care concerns.
• Develop and revise clinical care standards and guidelines.
• Support regulatory and accreditation functions (CMS, state, NCQA, URAC).
• Perform other job-related duties as requested.

Skills

Communication skills

Independent work

Relationship building

Attention to detail

Ethical standards

Critical thinking

Confidentiality

Diplomacy & cultural sensitivity

Decision making & problem solving

Conflict resolution

Mission-driven

Education

DO

MD

Business/Admin/Healthcare mgmt degree

Primary care residency

Five years clinical practice

Managed care medical review experience

Tools

Microsoft Word

Job description

CareSource is seeking a Medical Director to lead clinical review activities, provide education to providers, and support quality and regulatory initiatives across markets. The role emphasizes oversight of case management, data-driven improvements, and collaboration with market leadership.

The position requires DO or MD, board certification, residency in primary care, and a minimum of five years of clinical practice, with managed care experience preferred. Occasional travel may be involved.