Market Chief Medical Director(Must Have Michigan Licensure)

Job description

Job Summary: The Market Medical Director is responsible for the implementation of market-level clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards. Essential Functions: - Support staff by providing training, clinical consultation, and clinical case review for members - Participate in Interdisciplinary Care Team meetings, Inpatient Census Rounds and other clinical meetings - Support market provider network development and maintenance - Provides leadership to direct reports to achieve market goals - Provider education, training, data sharing, performance evaluations and orientation to the plan - Participate in peer-to-peer discussions - Participate in market level quality initiatives - Participate in community collaboratives - Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns - Provide cross-coverage for other Medical Directors and/or markets, as needed - Understand and provide support to prior authorization and utilization review functions - Conduct quality of care reviews - Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and co...