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Provider Job Details

Senior Medical Director, Health Alliance (Remote)

Job Type: Physician
Location: Urbana, IL
Check out this job opening for Carle Providers: Senior Medical Director, Health Alliance (Remote) Check out this job opening for Carle Providers: Senior Medical Director, Health Alliance (Remote)

Job Description

The Senior Medical Director assists the Associate Chief Medical Officer in promoting successful implementation of the medical, pharmaceutical and quality improvement management processes as Health Alliance. Responsible for analyzing complex medical situations and developing solutions within the limits of the member's benefits and the relevant policies. Serves on administrative and operational committees of Health Alliance as requested by the Associate Chief Medical Officer and or serves as medical adviser to the Medical Management, Quality Improvement, Provider Relations and Pharmacy departments. Interacts with network providers to ensure implementation of the Utilization Management, Case Management, Quality Improvement and Health Promotion/Disease Prevention programs.

May be responsible for new medical director on-boarding and training as well as other duties not assigned.

Job Functions:

  • Analyzes complex medical situations and develops solutions within the limits of the member's benefit package and relevant policies.
  • Serves on administrative and operational committees of Health Alliance Medical Plans as requested by the Associate Chief Medical Officer (i.e., Medical Directors' Committee, Quality Improvement Committee, Credentialing Committee, Pharmacy & Therapeutics Committee, Medical Policy Committee, etc.)
  • Serves as the medical adviser to the Medical Management, Quality Improvement, Provider Relations and Pharmacy Departments.
  • Interacts with network providers to ensure implementation of the Utilization Management, Quality Improvement and Health Promotion/Disease Prevention programs.
  • Adheres to and enforces Health Alliance Medical Plans Administrative and Departmental policies and procedures.
  • 100% Remote position

Experience Requirements:

  • Doctor of Medicine from an accredited school of medicine; board certification in primary area of clinical practice
  • 5 years of clinical practice experience beyond residency training
  • 3 years of health plan experience
  • Experience/working knowledge of Medicare Advantage

About Carle

Based in Urbana, IL, The Carle Foundation is a vertically integrated system with more than 9,500 employees in its five hospitals, multi-specialty physician groups, health plan and associated healthcare businesses including the Carle Illinois College of Medicine, the world’s first engineering-based medical school. Carle is proud to be named a Great Place to Work®. Carle Foundation Hospital and Carle BroMenn Medical Center hold Magnet® designation, the nation’s highest honor for nursing care and Carle Foundation Hospital (CFH) ranks as one of America’s 50 Best HospitalsTM by Healthgrades®.

Apply Now

Recruiter: Katie Schroeder

Title: Provider Career Liaison

Phone: (217) 326-2572

Fax: (217) 326-1714

Email: katie.schroeder@carle.com

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com. Positions are not available for remote work in the state of Colorado.

 

Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted. With an approved exemption, healthcare workers must do weekly testing and verify a negative COVID-19 test. Learn more about the vaccine requirement and Medical or Religious exemption.

 

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