Medical Director, Managed Care & Quality Oversight

Maryland-Care-Management-Inc; Linthicum (MD); On-site; USD 180,000 - 260,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

Employer-paid life insurance

Short & Long-Term Disability

401k with match

PTO 20 days

Tuition assistance

Job summary

Maryland Care Management Inc. (MCMI) seeks a Medical Director to lead MPCMCO’s Medical Management Program and to oversee Utilization Management, Quality Management, and inpatient concurrent review.

You will help develop medical policies and standards of care and provide direction to Health Management Teams. Ideal candidates hold an MD/DO with board certification and have experience in managed care, utilization review, and contract awareness.

Qualifications

• Knowledge of local, state, and national provider medical standards of care.
• Ability to build constructive relationships with diverse stakeholders.
• Proficiency with Microsoft Office and common office hardware.

Responsibilities

• Participate in Quality Management and Utilization Management processes.
• Consult with health professionals on concurrent review questions.
• Conduct peer-to-peer clinical case reviews with physicians for review determinations.
• Provide medical direction to the Pre-Authorization Unit for elective requests.
• Identify and report quality-of-care issues.
• Participate in Grievance and Appeals processes.
• Engage with QM/UM, Pharmacy & Therapeutics, and Credentialing committees.
• Collaborate with concurrent review nurses on inpatient rounds.

Skills

Provider standards

Relationship building

MS Office

Regulatory knowledge

Education

MD or DO with license

Active Board certification

Managed care experience

Utilization review experience

Tools

Microsoft Office Suite

Job description

Maryland Care Management Inc. (MCMI) seeks a Medical Director to lead MPCMCO’s Medical Management Program and to oversee Utilization Management, Quality Management, and inpatient concurrent review.

You will help develop medical policies and standards of care and provide direction to Health Management Teams. Ideal candidates hold an MD/DO with board certification and have experience in managed care, utilization review, and contract awareness.