Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.

Medical Director - PRN (Remote U.S.)

• Are you an experienced Medical Director looking for a new challenge?
• Are you looking to join a team that ensures a collaborative and inviting culture where everyone can thrive?

If so, you might be our next new team member!

Who we need:

The Medical Director provides the principal leadership and clinical expertise to operations on all medical aspects relating to the peer review process, utilization review activities, and other activities requiring clinical leadership and consultation. Additional key responsibilities may include assisting and promoting business development and strategic planning activities.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

Singularly Focused. Mission Driven.

Accelerating Better Outcomes is our Mantra! We are mission-driven to innovate health solutions that deliver maximum value and impact.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

What you’ll do:

• Evaluate, redirect and/or respond to inquiries from physicians, providers, and customers. Consult with general and/or specialty practitioners regularly and as necessary as business needs require.
• Foster appropriate external relationships with attending physicians/surgeons by response to telephone calls and letters, and speaking engagements before physician and provider organizations.
• Analyze and remain current on national, state, and local regulations and legislation, which impact the healthcare profession.
• Participate in activities specific to contractual arrangements, i.e. Fair Hearings.
• Provide medical expertise for planning and establishing goals and policies to improve medical management.
• Provides oversight of physician consultants and advisors. Conducts peer-to-peer physician consultations as requested/required; documents consultations.
• Work with medical, nursing, and administrative staff to identify matters needing shared attention.
• Discuss, inform, and facilitate communication and interaction between staff with customers.
• Create and complete initial and annual UM program evaluation that includes UM program recommendations
• Provide and review for medical necessity for services such as Advanced Imaging, Audiology, Chiropractic, Dental, DME, Home Health, Hospice, Inpatient, Mental Health (including Psychiatry), MRO, Occupational Therapy, Optometry, Outpatient, Pharmacy, Physical Therapy, Physician, Podiatry, Rehabilitation, Speech Therapy, Transplant, and Transportation.

What you’ll need:

Required Qualifications / Experience

• M.D. or D.O. with a current non-restricted license to practice medicine by the Board of Medical Examiners in the state of Indiana.
• Board certification in a clinical specialty.
• 5+ years of experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs, and coaching medical staff on healthcare business and practice issues.

Preferred Qualifications / Experience

• 10+ years of clinical practice.
• 2+ years as a Medical Director in a managed care company.
• Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare programs.
• Prior review experience or quality assurance committee responsibility in a hospital setting.

Knowledge, Skills, Abilities

• Strong knowledge in quality assurance and utilization review.
• Contemporary clinician who understands major trends in healthcare and managed care.
• Ability to work effectively with a diversity of personalities. Must be approachable; show respect for others, and a consensus builder.
• Systems thinker with strong organizational skills who can pull all the pieces together and deliver on time and within budget.
• Adaptable with a strong collaborative management style, a creative thinker with high energy and enthusiasm, and a team player who promotes the concepts of people working together.
• Able to adapt to frequently changing work parameters.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.