New

Medical Director

Spectraforce Technologies
United States, Florida, Jacksonville
13141 City Station Drive (Show on map)
Aug 08, 2025
Position Title: Medical Director Work Location: Remote (Flexible across time zones; candidates must support CST hours) Assignment Duration: 6-month contract with potential for extension or FTE conversion Work Schedule: 8:00 AM - 5:00 PM (including potential Saturday/Sunday and holidays) Work Arrangement: Remote (must be actively practicing physicians and have compact licensure) Position Summary: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Background & Context: Expansion hiring for CMS final rule compliance High volume case review environment; Level II reviewers needed for medical necessity determination psychiatric expertise with 12-15 UM case reviews/day Must be able to collaborate effectively with interdisciplinary teams, conduct Level II clinical reviews, and review experimental/complex medical services Key Responsibilities: Provides medical leadership of all utilization management, cost containment, and quality improvement activities Performs utilization review and medical review of complex, controversial, or experimental services Supports implementation of performance improvement initiatives for capitated providers Assists with planning and establishing care quality and cost-effectiveness policies Participates in physician committees, conducts rounds for high-risk patients, and collaborates with care management teams Reviews complex cases, appeals, claims, and new medical services for necessity Develops provider education on clinical issues and policy Identifies and executes utilization and clinical quality improvement studies Interfaces with providers to implement medical recommendations Builds provider alliances and represents the business unit in external settings For NH SUD Physician: oversees MCO's substance use clinical policies and protocols Qualification & Experience: Medical Doctor (MD) or Doctor of Osteopathy (DO) Actively practicing medicine (not just telehealth) Required: Board certification in Psychiatry (for Behavioral Health roles) Compact license and current unrestricted state medical license 3-5 years of recent, in-office patient practice experience Preferred: Utilization Management (UM) experience Knowledge of quality accreditation standards Coursework in Health Administration, Financing, Insurance, or Personnel Management Experience with culturally diverse populations Familiarity with care management systems Certification in addiction medicine or sub-specialty (as applicable by state) Experience treating substance use or complex mental health needs (state-specific roles) Notes: (Behavioral Health): Board Certified in Psychiatry required Daily UM caseload expectations: 12-15 decisions Must be willing to work weekends as needed Must be able to obtain licensure in multiple states Position is offered by a no fee agency.