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Job description
Job Summary
The Medical Director, Neonatology is responsible for providing subject matter expertise and medical leadership in the development of utilization management, care management and quality of care programs for infant and neonatology services.
Essential Functions
Work directly with Vice Presidents of Utilization Management, Care Management and Medical Directors to achieve desired utilization, care management and quality of care objectives for this newborn and infant members and their mothers
Support staff by providing training, clinical consultation, and clinical case review for members
Provide prior authorization medical reviews, consultation and clinical review services
Participate in peer-to-peer discussions
Provide provider education, training, data sharing, performance evaluations and orientation to the plan
Provide physician review for clinical appeals cases
Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
Participates in quality improvement initiatives, case management activities and member safety activities (i.e. incident management Oversight and quality improvement activities associated with case management activities
Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to managed care plan staff and providers as appropriate
Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
Collaborate with market/product leaders to help define market strategy
Work with market leaders to be a liaison to community based organization and health systems regarding neonatal care both prevention and care coordination and management
Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
Actively participate in Utilization Management (UM) rounds and education of UM staff on NICU utilization management, levels of care and quality of care
Participate in the development /ongoing improvement in the transitions of care for NICU members that graduate from NICU
Actively participate in creating of formal clinical policy for NICU and post NICU transitions/care management
Perform any other job duties as requested
Education and Experience
Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required
Successful completion of a residency training program in pediatrics and neonatology fellowship required or equivalent experience
Minimum of five (5) years of clinical practice experience is required
Managed care medical review/medical director experience is preferred
Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is desirable
Competencies, Knowledge and Skills
Basic Microsoft Word skills
Excellent communication skills, both written and oral
Ability to work well independently and within a team environment
Ability to create strong relationships with Providers and Members
High ethical standards
Attention to detail
Critical listening and systematic thinking skills
Ability to maintain confidentiality and act in the company’s best interest
Ability to act with diplomacy and sensitivity to cultural diversity
Decision making/problem solving skills
Conflict resolution skills
Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served
Licensure and Certification
Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required
Board Certification, preferably in primary care specialty (Pediatrics) is required as well as board certification in Neonatology
Re-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer)
Working Conditions
General office environment
May be required to sit or stand for extended periods of time
May be required to work evenings/weekends
May be required to travel to fulfill duties of position
Compensation
Compensation Range: $195,200.00 - $341,600.00
Compensation Type (hourly/salary): Salary
In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Organization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
Equal Opportunity and Diversity
CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Mission and Culture
CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.
Other
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.
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Worksite address
dayton, OH, 45444, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.