Kepro - Medical Director (M.D. or D.O. state of Indiana) - Reside in Indiana (Hybrid)

Company Description

Kepro and CNSI have merged.

Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, and in the right setting.

Job Description

Medical Director

• Are you an experienced Medical Director looking for a new challenge?
• Do you value care management and quality improvement?
• Are you motivated, energetic, and excited to become part of the Kepro team?

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, case management, and other activities requiring clinical leadership and consultation. Additional key responsibilities may include assisting and promoting business development and strategic planning activities.

Why us?

Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, and in the right setting.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

We do this through our people.

At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.

Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. 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 customer. Consult with general and/or specialty practitioners regularly and as necessary as business needs require.
• Represent and promote KEPRO at seminars, professional societies, medical staff meetings, and other professional settings as appropriate.
• Foster appropriate external relationships with attending physicians/surgeons by response to telephone calls and letters, speaking engagements before physician and provider organizations.
• Analyze and remain current on national, state, and local regulations and legislation, which impacts the health care profession.
• Review medical information trends, experiences and approaches, and assists in the development of strategic plans for clinical improvements.
• Ensures compliance with regulatory and accreditation requirements.
• Responsible for oversight of medical content of company publications.
• Participate in activities specific to contractual arrangements, i.e. Fair Hearings.
• Provide medical expertise with respect to 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.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

What you’ll need:

Required Qualifications

• 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.
• License must be in the same state as contractually req