Medical Director

SoTalent • Full-time • New York, United States • 8h ago

About the job

Job Title: Medical Director

Location : New York, United States

Type: Full Time

Our client looking for a Medical Director to support clinical leadership and oversight across our care management, quality, and credentialing operations.

In this role, you’ll partner closely with the Chief Medical Director to guide medical management strategies, ensure clinical excellence, and drive improvements in both quality outcomes and cost‑effectiveness for our members.

What You’ll Do

Provide clinical leadership for utilization management, quality initiatives, and cost‑effectiveness programs.
Review complex or unique medical cases to ensure timely, accurate decisions regarding clinical necessity.
Support and advance performance improvement efforts across provider groups and care teams.
Partner with the Chief Medical Director to establish goals, policies, and operational enhancements that elevate care and service.
Contribute medical expertise to utilization review and quality programs in accordance with regulatory and accreditation standards.
Assist with the structure and function of physician committees, helping maintain engagement and effectiveness.
Participate in patient care rounds to coordinate services for high‑risk individuals and support care management teams.
Collaborate with clinical teams, network providers, pharmacy and medical consultants, and appeals teams on complex case decisions and appeals.
Play a role in expanding the provider network and supporting new market entry where needed.
Help design and deliver education for physicians related to clinical policies and best practices.
Identify trends in utilization, provider patterns, and benefit design impacts to support operational improvements.
Recommend and support clinical quality studies aimed at reducing unnecessary variation in practice.
Communicate with providers to implement recommendations that improve care delivery and resource use.
Review unusual or emerging services to determine clinical appropriateness and payment eligibility.
Strengthen relationships with providers through collaborative medical management programs.
Represent the organization at state-level meetings, industry gatherings, or public forums when needed.
Participate in weekend or holiday operations during periods of high demand or organizational need.

What You Bring

Medical Doctor (MD) or Doctor of Osteopathy (DO).
Active clinical practice experience.
Background in utilization management and quality standards is helpful.
Knowledge of healthcare administration, financing, insurance, or personnel management is beneficial.
Experience working with diverse patient populations.

Licensing & Certification Requirements

Board certification in a recognized medical specialty.
Board certification in Psychiatry is required.
Active, unrestricted medical license (MD or DO) in the state of New York.
No sanctions or limitations from federal or state programs.

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