Medical Director - Dual-Eligible Special Needs Plan / Medicare-Medicaid Plan

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Primary Responsibilities:

• Responsible for clinical oversight of DSNP/MMP complex populations (Dual-Eligible Special Needs Plan / Medicare-Medicaid Plan) • Develop and lead clinical strategy and objectives for the DSNP/FIDE populations, including the development and implementation of clinical initiatives and programs to address the needs of the populations managed to improve health outcomes. • Leverage extensive knowledge of health care delivery system, utilization management, reimbursement methods and treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment, clinical quality, and care management. • Actively participate in meetings and communication with the State Department of Medicaid in person as needed.

• Develop and guide the implementation of Medical Management programs to ensure providers deliver appropriate, high-quality, cost-effective Health Risk Assessments and other clinical services that are evidence-based. • Work collaboratively with the Behavioral Health, Pharmacy, Member Outreach, Care Management, National Quality Management, Utilization Management, Compliance, and other departments to integrate social, behavioral, and physical health and improve clinical program execution.

Required Qualifications:  • MD or DO Degree and Currently Board Certified in Internal Medicine, Family Medicine, or Geriatric Medicine. "Board Eligible" will not meet requirements.

Licensed in at least one state with the ability to get licensure in Ohio, New York, New Jersey, Virginia, Michigan, Florida and others as needed. Florida Location and Florida License is REQUIRED.

• Active Unrestricted Board Certification in ABMS or AOA specialty. 

• Five 5+ years of clinical practice experience post residency, including experience with complex health populations and services (must have at least three years of training in a medical specialty). 

• Three 3+ years of experience in the managed care industry. 

• Experience in leading interdisciplinary teams. 

• Solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles.

• Ability to travel on as needed basis; planned and scheduled in advance only if needed from time time.  

• Proven ability to develop relationships with network and community physicians and other providers.

Education: 

MD or DO Boarded in a Primary Care Specialty (Internal Medicine, Family Medicine, Geriatrics)