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Medical Director

Spectraforce Technologies
United States, North Carolina, Raleigh
500 West Peace Street (Show on map)
Jul 10, 2025

Position Title: Medical Director

Work Location: Remote - Nationally Sourced

Assignment Duration: 6 months with potential to extend or convert

Work Schedule: 8 am - 5 pm in candidate's time zone (EST, CST, PST)

Position Summary:

* Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.

Key Responsibilities:

* Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.

* Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making.

* Supports effective implementation of performance improvement initiatives for capitated providers.

* Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.

* Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.

* Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.

* Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.

* Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.

* Participates in provider network development and new market expansion as appropriate.

* Assists in the development and implementation of physician education with respect to clinical issues and policies.

* Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.

* Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.

* Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.

* Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.

* Develops alliances with the provider community through the development and implementation of the medical management programs.

* As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.

* Represents the business unit at appropriate state committees and other ad hoc committees.

* May be required to work weekends and holidays in support of business operations, as needed.

* Performs other duties as assigned

* Complies with all policies and standards

Qualification & Experience:

* Medical Doctor or Doctor of Osteopathy

* Utilization Management experience

* Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association's Department of Certifying Board Services (Psychiatry if Behavioral Health)

* Current state medical license without restrictions

* Course work in Health Admin, Financing, Insurance preferred

* Experience treating or managing care for culturally diverse population preferred



Candidate Requirements
Education/Certification Required: Medical Doctor or Doctor of Osteopathy.

Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association's Department of Certifying Board Services.
Preferred:
Licensure Required: need to be licensed Preferred:


  • Years of experience required
  • Disqualifiers
  • Best vs. average
  • Performance indicators


Must haves:

UM experience (minimum of 1 year experience)

Nice to haves:

Medicare UM experience

Extensive state licensing

Disqualifiers:

Not meeting the board certification

Performance indicators:

Production capacity around the 45 cases per day

Quality of the review

A strong candidate would meet the following:

  1. Clinical Expertise: Board-certified physician with active practice experience.
  2. UM Proficiency: Proven ability to handle high-volume case reviews efficiently and accurately.
  3. Behavioral Health Experience: Especially valuable if applying for roles requiring psychiatry certification.
  4. Tech Savvy: Comfortable using EMR systems and collaborating virtually.
  5. Adaptability: Can work independently in a remote setting while engaging with a dynamic team.
  6. Regulatory Knowledge: Familiarity with accreditation standards and state-specific requirements.


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