Medical Director

Job Title: Medical DirectorLocation: Position needs a Massachusetts Medical License, but person can sit anywhere in US.Type: 1 year contract, Ad hoc basisNOTEThis position would only be needed if one of our LTSS Medical Directors could not cover for the other.This could be in case of PTO, medical leave, unforeseen circumstances. We would like for someone to learn the LTSS case review process in case one of our LTSS Medical Directors is not available. This would be ad hoc only. It would be a position more akin to having a contracted LTSS Medical Director in the wings in case they are needed. This position would require approximately 5 weeks throughout the year.Description:Responsibilities for a Medical Director include:-Performs daily review of home and community-based services to approve or deny appropriate services for members. Will work with nursing staff to clarify requests and documentation as needed-Represents the health plan in Board of Hearing cases-Responsible for appropriate utilization management including managing/monitoring the results of Care Management/ Health services interventions to ensure that utilization goals are achieved; collaborating with Care Management/ health services/behavioral health as necessary to maintain focus on achieving targets.-Works toward fully integrated clinical model working with Behavioral Health and clinical management-Supports all clinical quality initiatives and peer review processes-Collaborates with the health plan Chief Medical Officer, and other clinical staff as a clinical resource and coach to support programs and health plan goalsCollaborates with the Chief Medical Officer, clinical operations staff, and other market staff to support and meet market and national clinical operations goals.-Accountable for providing clinical leadership primarily focusing on home and community-based services review and external communication with network physicians-May assist in the development and implementation of local plan clinical policies and procedures, quality improvement activities and performance improvement projectsQualifications:Active/unrestricted Licensed physicianBoard Certified in an ABMS or AOBMS specialty5+ years clinical practice experience; strong knowledge of managed care industry and the Medicaid line of business.2 - 3 years Quality management experienceFamiliarity with current medical issues and practicesStrong leadership skills as demonstrated by continuously improved results/team building, and effectiveness in a highly matrixed organizationExcellent interpersonal communication skillsSuperior presentation skills for both clinical and non-clinical audiencesProven ability to develop relationships with network/community physicians and other providersExcellent project management skillsSolid data analysis and interpretation skills; ability to focus on key metricsStrong team player and team building skillsStrategic thinking with proven ability to communicate a vision and drive resultsSolid negotiation and conflict management skillsCreative problem-solving skills.Proficiency with Microsoft Office applications

Created: 2026-05-12