The Medical Director (MD) is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive medical care. The MD is a critical medical and business leader and contact for external providers, plan sponsor, and regulatory agencies and participates in the strategic medical management for our plan sponsors. Oversees the quantity and quality of comprehensive medical care provided.

Main functions of a Medical Director:

• Holds a senior medical position in a medical group independent practice association.
• Responsible for a number of activities related to the management of medical care and clinical services such as cost management, utilization review, quality assurance, and medical protocol development
• Oversees the oversight of group physician activity, including the recruiting and credentialing processes
• Reports to the physician CMO/president and/or to the governing body of the organization

Directorship duties and responsibilities:

• Attend standing meetings (board, committee, etc.)
• Monitor quality and appropriateness of medical care
• Provide guidance and leadership for performance guidelines
• Assist in development of policies and procedures
• Participate in the management of strategic development
• Participate in clinical peer review oversight
• Participate in documentation and care planning
• Assist in management of physician relations and/or representation
• Address emergency issues
• Support physician education
• Assist in management of community relations
• Assist in guidance for performance guidelines
• Oversight of transactional activities: Prior authorization; concurrent review; retro- active review; claim review
• Provides physician oversight of medical care management and utilization review in all offices. Provides clinical guidance in complex medical decision processes

• Meet compliance standards, contractual and legislative.
• Assist in care management and coordination activities
• Assist in staff training: Physician, Case Managers, and UM Staff
• Become proficient with company software programs.
• Assist in “Carve Out Program” management and develop proficiency with and understanding of Carve Outs (CCS, LEA, Etc.)
• Assist in coordination activities with contracted Health Plans and County Health Agencies
• Work with contracted medical providers and business partners to implement programs and resolve problems related to medical case management.
• Act as Medical Resource to staff
• Maintain professional affiliations and enhance professional growth and development to stay current in medical trends
• Adhere to company policies and procedures, guidelines, and directives.
• Maintain strict operating and patient confidentiality
• Contributes to a healthy, positive and safe environment and promotes self as a team member

- Sacramento is the state's capital has over 450,000 residents
- It has plentiful amenities including an int'l airport and an NBA basketball team
- San Francisco is only 1.5 hours, Napa is only 30 minutes and Lake Tahoe is 2 hours