What are the responsibilities and job description for the Director of Medical Services position at Coordinated Care?
About the Position
This clinical leadership role supports the Chief Medical Director in directing medical management, quality improvement, and credentialing functions for our business unit.
- Provide medical guidance on utilization management, cost containment, and quality improvement initiatives.
- Lead medical review activities for complex, controversial, or experimental medical services, ensuring timely and high-quality decision-making.
- Support effective implementation of performance improvement initiatives for capitated providers.
- Assist the Chief Medical Director in planning goals and policies to improve care and service quality for our members.
- Contribute medical expertise to quality improvement and utilization management programs in accordance with regulatory requirements.
- Collaborate with physician committees to structure, process, and membership functions.
- Conduct regular rounds to assess and coordinate care for high-risk patients, working with care management teams to optimize outcomes.
- Work effectively with clinical teams, network providers, appeals teams, medical consultants, and pharmacy consultants for reviewing complex cases and medical necessity appeals.
- Participate in provider network development and new market expansion as necessary.
- Support the development and implementation of physician education related to clinical issues and policies.
