Senior Medical Director, Post-Service & Claims Review

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

Benefits offered by this job

Bonus potential

Total rewards package

Job summary

CareSource is seeking an Enterprise Medical Director to lead development, implementation and revision of corporate clinical care standards and practice guidelines. You will ensure alignment with national quality standards while guiding quality initiatives and policy development.

The role requires MD/DO with residency in primary care, 5+ years clinical practice, and preferred managed care medical review experience. Expect collaboration across markets and ongoing staff support and education.

Qualifications

• MD/DO required with medical Florida license or eligibility.
• Residency trained, primary care preferred.
• Minimum 5 years of clinical practice; managed care medical review experience preferred.

Responsibilities

• Develop, implement and revise the Quality Improvement Plan and corporate quality initiatives.
• Develop policies and procedures; provide clinical leadership and training.
• Support regulatory/compliance (CMS, state, NCQA, URAC) across programs.

Skills

Excellent communication

Independent work

Provider/member relationships

Attention to detail

Critical thinking

Data interpretation

Education

M.D. or D.O. in Medicine

M.B.A./Healthcare Admin/Medical Management preferred

Tools

Microsoft Word

Job description

CareSource is seeking an Enterprise Medical Director to lead development, implementation and revision of corporate clinical care standards and practice guidelines. You will ensure alignment with national quality standards while guiding quality initiatives and policy development.

The role requires MD/DO with residency in primary care, 5+ years clinical practice, and preferred managed care medical review experience. Expect collaboration across markets and ongoing staff support and education.