Medical Director: Clinical Quality & Strategy Lead

CareSource; Dayton (OH); Hybrid; USD 195,000 - 342,000; Full time

Job summary

CareSource in the United States (OH) is seeking a Medical Director to support staff through training, clinical consultation, and case review for members. The role leads clinical reviews, education, and provider engagement to ensure high-quality care and regulatory compliance.

The position emphasizes collaboration with cross-functional teams, participation in fraud/abuse investigations, and development of clinical standards. A DO/MD with extensive clinical experience is required.

Qualifications

• DO or MD required; residency in primary care preferred
• Five years of clinical practice experience required
• Board Certification preferred
• MCG Certification required or within six months of hire

Responsibilities

• 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 as requested
• Provide physician review for clinical appeals cases
• Participate in evaluation of cases suspected of fraud, abuse, and quality of care concerns
• Participate in development of policies and procedures
• Engage in quality improvement initiatives and case management activities
• Collaborate with market/product leaders to define market strategy
• Support regulatory and accreditation functions and compliance for all programs
• Review utilization data to identify variances and educate staff and providers

Skills

Excellent communication skills

Attention to detail

Independent work

Team collaboration

Education

DO or MD required

MBA/Healthcare Admin preferred

Tools

Microsoft Word

Job description

CareSource in the United States (OH) is seeking a Medical Director to support staff through training, clinical consultation, and case review for members. The role leads clinical reviews, education, and provider engagement to ensure high-quality care and regulatory compliance.

The position emphasizes collaboration with cross-functional teams, participation in fraud/abuse investigations, and development of clinical standards. A DO/MD with extensive clinical experience is required.