What are the responsibilities and job description for the Quality Care Specialist position at Coordinated Care Services Inc?
Join us at Coordinated Care, where we are dedicated to delivering high-quality medical services to our 28 million members.
Responsibilities : The Medical Director will oversee the medical management, quality improvement, and credentialing functions for our business unit, ensuring timely and quality decision-making.
Key Functions :
Provide medical leadership on utilization management, cost containment, and medical quality improvement activities, including supporting the Chief Medical Director in planning and establishing goals and policies.
Conduct regular reviews of claims involving complex, controversial, or unusual or new services to determine medical necessity and appropriate payment.
Collaborate with physicians and other providers to develop and implement recommendations that would improve utilization and health care quality.
Participate in the development and implementation of physician education on clinical issues and policies, including courses in Health Administration, Health Financing, Insurance, and / or Personnel Management.
Interface with physicians and other providers to facilitate implementation of recommendations that would improve utilization and health care quality.
Requirements :
Medical Doctor or Doctor of Osteopathy degree
Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Associations Department of Certifying Board Services
Current Washington state license as a MD or DO without restrictions, limitations, or sanctions from government programs
Actively practices medicine and has experience treating or managing care for a culturally diverse population
Benefits :
Competitive pay and benefits package
401K and stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field, or office work schedules
