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Medical Director(Must Live In Massachusetts)

May 27, 2026

Job Summary:The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members.Essential Functions:<ul><li>Provide prior authorization medical reviews, consultation and clinical review services</li><li>Participate in peer-to-peer discussions</li><li>Provide provider education, training, data sharing, performance evaluations and orientation to the plan</li><li>Conduct clinical reviews for designated CareSource members as requested</li><li>Provide physician review for clinical appeals cases</li><li>Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns</li><li>Participate in development of policies and procedures</li><li>Participates in quality improvement initiatives, case management activities and member safety activities (i.e. incident management</li><li>Provide cross-coverage for other Medical Directors and/or markets, as needed</li><li>Oversight and quality improvement activities associated with case management activities</li><li>Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate</li><li>Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards</li><li>Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives</li><li>Collaborate with market/product leaders to help define market strategy</li><li>Community collaborative participation</li><li>Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs </li><li>Perform any other job related instructions, as requested</li></ul>Education and Experience:<ul><li>Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required</li><li>Successful completion of a residency training program, preferably in primary care is required</li><li>Minimum of five (5) years of clinical practice experience is required</li><li>Managed care medical review/medical director experience is preferred</li><li>Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred</li></ul>Competencies, Knowledge and Skills:<ul><li>Basic Microsoft Word skills</li><li>Excellent communication skills, both written and oral</li><li>Ability to work well independently and within a team environment</li><li>Ability to create strong relationships with Providers and Members</li><li>High ethical standards</li><li>Attention to detail</li><li>Critical listening and systematic thinking skills</li><li>Ability to maintain confidentiality and act in the company’s best interest</li><li>Ability to act with diplomacy and sensitivity to cultural diversity</li><li>Decision making/problem solving skills</li><li>Conflict resolution skills</li><li>Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served</li></ul>Licensure and Certification:<ul><li>Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required</li><li>Board Certification, preferably in primary care specialty is required</li><li>Re-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer)</li><li>MCG Certification is required or must be obtained within six (6) months of hire</li></ul>Working Conditions:<ul><li>General office environment; may be required to sit or stand for extended periods of time</li><li>May be required to work evenings/weekends</li><li>May be required to travel to fulfill duties of position</li></ul>Compensation Range:$195,200.00 - $341,600.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary):SalaryOrganization Level Competencies <ul><li style="text-align:left">Fostering a Collaborative Workplace Culture</li><li style="text-align:left">Cultivate Partnerships</li><li style="text-align:left">Develop Self and Others</li><li style="text-align:left">Drive Execution</li><li style="text-align:left">Influence Others</li><li style="text-align:left">Pursue Personal Excellence</li><li style="text-align:left">Understand the Business</li></ul> <h2>This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.</h2>#LI-SW2

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

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When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

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6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

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Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

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