Medical Director - Medicare Case Management

Remote, USA Full-time Posted 2026-05-04
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Description:
• Provides clinical oversight of case management teams.
• Participates in the development of Individual Care Plans (ICP).
• Collaborates with leadership to ensure objectives are met.
• Consults with plan medical staff on adverse determinations.
• Delivers highest quality care in an effective manner.
• Contributes to strategies and programs for community engagement.
• Develops clinical training for case management staff.
• Ensures timely execution of all deliverables.
• Interprets utilization data and proposes clinical improvements.
• Participates in UM activities and on-call schedule as needed.

Requirements:
• Active and current medical license in Florida (MD or DO).
• Board Certification in Family Practice, Internal Medicine, or Geriatrics.
• Post-graduate direct patient care experience.
• 3-5 years of Managed Care experience; Medicare highly preferred.
• 3-5 years of Case Management experience.
• Ability to work effectively in a highly matrixed organization.
• Ability to engage with all levels including clinical leaders and staff.
• Flexibility with work schedule to meet business needs.
• Ability to be agile and manage multiple priorities.

Benefits:
• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan available.
• Fully-paid term life insurance plan.
• Short-term and long-term disability benefits.
• Numerous well-being programs.
• Education assistance and free development courses.
• CVS store discount and discount programs with partners.
• Paid Time Off (PTO) and paid holidays.

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