The Medical Director participates in the broad array of
activities of the Medical Services area including Medical and
Pharmacy Utilization Management, quality management, case
management, credentialing, and corporate medical policy processes.
The incumbent also provides input into the development of policies,
programs and strategic objectives that cover Medical Management
Services, and acts as a liaison with local physicians and
hospitals, and keeps abreast of medical policies and procedures
within the medical community.
• Assists the Medical Services Department with Utilization
Review and Case Management activities. These activities do not, in
any way, constitute practicing medicine.
• Reviews and makes recommendations and/or decisions on
Utilization or Case Management activities; utilization review
activities include reviews of requests for broad range of medical
services including medications, medical and surgical services at
first level, appeal and inquiries.
• Makes accurate and consistent interpretation of integral
medical policy, contract benefits and State and Federal Mandates
and maintains current and working knowledge of Utilization
• Clinical skills are excellent and evidence based medicine
skills are such that the individual provides review oversight for a
broad array of clinical services.
• Reviews and makes recommendations on medical policies,
guidelines and medical criteria.
• Provides input into the utilization management program
policies and procedures.
• Assists with training medical director colleagues, nursing
staff including leadership of teaching grand round activities.
• Assists the staff during high peak activity or staff
• Act as a resource to legal counsel; and provides testimony in
legal proceedings as required.
• Maintains professional contacts with local Physician community
and keeps abreast of medical and managed care trends.
• Attends medical policy, medical director meetings and staff
grand rounds meetings
• Take week-end call, as assigned.
• Consistently demonstrates high standards of integrity by
supporting the Lifetime Healthcare Companies’ mission and values
and adhering to the Corporate Code of Conduct, and Leading to the
Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with
the corporate privacy policies and procedures.
• Maintains knowledge of all relevant legislative and regulatory
mandates and ensures that all activities are in compliance with
• Conducts periodic staff meetings to include timely
distribution and education related to departmental and
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
• The position is considered an exempt employee status with an
expectation to work those hours which are required to accomplish
the work deliverables including occasional evenings during high
volume periods and staff shortages (e.g. cross coverage
• Work from home is an option with an expectation of full
compliance with the corporate ‘Work from Home’ policy
Level II – Performs similar functions as level I, plus:
• Reviews medical literature and applies evidence based
principles using high proficiency skills for a broad range of
• Reviews internal trend reports to assess present and future
needs and opportunities.
• Interacts with regulatory and accreditation agencies as
• Provides clinical support to the Sales and Marketing
• Provides clinical leadership for the implementation of new
utilization/case/quality management initiatives
We include multiple levels of classification differentiated by
demonstrated knowledge, skills, and the ability to manage
increasingly independent and/or complex assignments, broader
responsibility, additional decision making, and in some cases,
becoming a resource to others. In addition to using this
differentiated approach to place new hires, it also provides
guideposts for employee development and promotional
• Medical Degree (MD) required.
• Active unrestricted medical license; appropriate and current
• A minimum of ten years medical experience and strong working
knowledge of QM/UM and credentialing activities or (5) years of
comparable health plan experience.
• Ability to identify, analyze and resolve complex medical
• Skills in evidence based medicine.
• Strong interpersonal skills essential for communication to
staff at all levels of the organization.
• Basic skill sets in electronic communication systems such as
e-mail and Word.
Level II – requires similar qualifications as level I, plus:
• Superior evidence based medicine skill set
• Strong interpersonal skills essential for communication to
physicians in the community.
• Strong verbal presentation skills to lead internal and
external discussions at board levels
• Advanced skill sets in electronic communication systems such
as e-mail, Word, PowerPoint, and Excel.
The Physician is not the subject of any pending professional
disciplinary action impairing his/her ability to practice
The Lifetime Healthcare Companies aims to attract the best
talent from diverse socioeconomic, cultural and experiential
backgrounds, to diversify our workforce and best reflect the
communities we serve.
Our mission is to foster an environment where diversity and
inclusion are explicitly recognized as fundamental parts of our
organizational culture. We believe that diversity of thought and
background drives innovation which enables us to provide
leading-edge healthcare insurance and services. With that mission
in mind, we recruit the best candidates from all communities, to
diversify and strengthen our workforce.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that
include compassion, pride, excellence, innovation and having fun!
We aim to be an employer of choice by valuing workforce diversity,
innovative thinking, employee development, and by offering
competitive compensation and benefits.
In support of the Americans with Disabilities Act, this job
description lists only those responsibilities and qualifications
deemed essential to the position.
Equal Opportunity Employer
Qualifications Education Required
Physician or better in Physician.
Licenses & Certifications Required
Equal Opportunity Employer/Protected Veterans/Individuals with
The contractor will not discharge or in any other manner
discriminate against employees or applicants because they have
inquired about, discussed, or disclosed their own pay or the pay of
another employee or applicant. However, employees who have access
to the compensation information of other employees or applicants as
a part of their essential job functions cannot disclose the pay of
other employees or applicants to individuals who do not otherwise
have access to compensation information, unless the disclosure is
(a) in response to a formal complaint or charge, (b) in furtherance
of an investigation, proceeding, hearing, or action, including an
investigation conducted by the employer, or (c) consistent with the
contractor’s legal duty to furnish information. 41 CFR