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The CommuniCare Family of Companies currently owns/operates more than 85 Nursing and Rehabilitation Centers, Specialty Care Centers and Assisted Living Communities in 7 states. Since 1984, CommuniCare Health Services has provided superior, comprehensive management services for the development and management of adult living communities.

Due to growth, we are seeking an experienced Associate Medical Director. The position of part‑time Associate Medical Director is responsible for supporting the Medicare Advantage Plans clinical and quality activities and operations at the direction of the Chief Medical Officer approximately 25 hours per week. This position reports directly to the Chief Medical Officer, Medicare Advantage Plans.

Responsibilities

Medical Management

Support strategies and interventions to improve quality outcomes, medical expense trends, and STARS ratings

Health Care Services Management

Conduct prior authorization and utilization management activities including adverse determinations

Collaborate with consultant physicians as necessary to review selected authorization requests or appeals of adverse determinations

Support processes relating to performance and audit of vendors or provider organizations delegated for UM

Lead review and submission of clinical practice guidelines, utilization and concurrent review criteria, and other similar guidelines to Medical Policy or applicable committees

Participate in Plan committees such as Medical Policy, Credentialing, Quality Improvement, Peer Review and others as assigned

Collaborate with medical directors and other clinical leaders from across the contracted network including CHS affiliates as on assigned projects

Support care innovations across the enterprise

Support the implementation and execution of the Quality Assurance Plan including but not limited to Models of Care, STARS and clinical quality, Member and provider satisfaction, Provider network accessibility, availability and qualifications, Grievance and Appeals, Plan Pharmacy Operations, Pharmacy related meetings, Pharmacy appeals process, Regulatory and Compliance, Annual Plan compliance training, Documentation, Quality Committees, Physician Recruitment, Physician and hospital relationships, Member outcome initiatives, Provider network participation, and ambassador to other enterprise Medical Directors and clinical leaders

Qualifications & Experience Requirements

Requires a degree in medicine from an accredited school, Board Certification, and is licensed to practice in applicable states in which the Plan operates

Requires at least 15 years of Clinical Experience

Requires 3 to 5 years prior experience as a CMO or Associate Medical Director preferably for a Medicare, MMP, or Medicaid plan inclusive of dually eligible enrollees

Experience in working in post‑acute facilities, assisted living facilities, home and community‑based service settings preferred

Geriatric training and experience preferred but not required

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