Medical Director - Sunshine State Health Plan

Overview

Sunshine State Health Plan is a leading healthcare provider in the Florida region, offering comprehensive services to its 28 million members. We are seeking an experienced Medical Director to join our team and lead our medical management, quality improvement, and credentialing functions.

• Key Responsibilities:

• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical review activities for utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
• Support effective implementation of performance improvement initiatives for capitated providers.
• Assist in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
• Collaborate effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
• Participate in provider network development and new market expansion as appropriate.

Requirements:

We seek a qualified candidate who is actively practicing medicine and has experience in utilization management and quality accreditation standards. Board certification by the American Board of Psychiatry and Neurology and a current Florida state medical license without restrictions are also required.

Benefits:

Sunshine State Health Plan offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.