Medical Director Physician
MedStar Health
Not Specified, MD, USA
Not Specified, MD, USA
- Healthcare
- Medical Director
- Physician
- Medicaid Managed Care
The Medical Director Physician will oversee clinical and operational functions within a Medicaid Managed Care health plan, including case management, disease management, and utilization review. The role involves daily review of inpatient cases, precertification, pharmacy requests, emergency visits, and appeals to ensure appropriate utilization and compliance with health plan criteria. Candidates must have clinical experience, leadership skills, and medical licensure in the DC/Maryland area.
We are looking for a physician with primary care and health plan experience to join MedStar Family Choice, our Medicaid Managed Care organization, as the health plan Medical Director in the Baltimore, MD area. In this position you will participate in the development and daily execution of case management, disease management, population health management, utilization review and other operations of the health plan. You will also conduct a daily review of current inpatients, precertification requests, pharmacy requests, review of emergency department visits, review of appeals, and consultations with nurse case managers and other associates to ensure the daily operations of the plan. Utilization review decisions for members of MedStar Family Choice (MFC) are made according to Utilization Management (UM) criteria and based on medical necessity and the existence of coverage.
Qualified candidates will have 5 years of clinical experience with progressively responsible leadership experience. Health plan experience preferred. Candidates must reside in the DC / Maryland area. The selected candidate must possess medical licensing in DC and Maryland.
If you're interested please use the link below to apply!
Qualified candidates will have 5 years of clinical experience with progressively responsible leadership experience. Health plan experience preferred. Candidates must reside in the DC / Maryland area. The selected candidate must possess medical licensing in DC and Maryland.
If you're interested please use the link below to apply!




