Medical Director - Carolina Complete Health
- Assist the Chief Medical Officer to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.
- Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
- Assists Chief Medical Officer in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
- Assists the Chief Medical Officer in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities of physician advisors. Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
- Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
- Develops alliances with the provider community through the development and implementation of the medical management programs.
MD or DO, board certified preferable in a primary care specialty. Actively practicing physician preferred. Previous experience within a managed care organization is preferred. Experience treating or managing care for a culturally diverse population preferred.
Board Certification through American Board Medical Specialties.
North Carolina state medical license without restrictions.
Posted March 24, 2021