About the role
TSS Medical Director (Ad Hoc / Backup Coverage) About The Role This ad hoc LTSS Medical Director position provides backup coverage when one of the primary LTSS Medical Directors is unavailable due to PTO, medical leave, or unforeseen circumstances. The physician will be trained in the LTSS case review process and serve as an on‑call clinical leader capable of stepping in as needed.
Coverage is approximately 5 weeks per year , and the candidate must be willing to cover holidays .
Pay Rate: $120-$125/hr
Responsibilities
- Home & Community-Based Services Review — Conduct daily LTSS case reviews to approve or deny services based on medical necessity. Collaborate with nursing staff to clarify documentation.
- Board of Hearings Representation — Represent the health plan in Board of Hearing cases, presenting clinical rationale and supporting defensible determinations.
- Utilization Management — Monitor utilization trends and collaborate with Care Management, Health Services, and Behavioral Health to achieve UM goals.
- Integrated Clinical Collaboration — Support integrated clinical models across Behavioral Health and clinical operations.
- Clinical Quality & Peer Review — Participate in quality initiatives, peer review processes, and performance improvement projects.
- Cross-Functional Leadership — Partner with the CMO and clinical operations teams to support market and national clinical goals.
- Provider Communication — Serve as a clinical liaison to network physicians and community providers.
- Policy & Program Support — Assist in developing and implementing clinical policies, procedures, and improvement initiatives.
Minimum Qualifications
- Active, unrestricted Massachusetts medical license
- Board Certification in an ABMS or AOBMS specialty
- 5+ years clinical practice experience
- Strong knowledge of managed care and Medicaid LTSS
- 2–3 years quality management experience
- Excellent interpersonal and presentation skills
- Proven ability to build relationships with physicians and providers
- Strong project management and data interpretation skills
- Effective negotiation and conflict management abilities
- Proficiency with Microsoft Office
Preferred Qualifications
- Experience with LTSS or home/community-based services
- Prior utilization management or medical director experience
- Experience working in highly matrixed organizations
- Strategic thinking with demonstrated ability to drive results
Position Details
- Type: Ad hoc / backup coverage
- Estimated Coverage: ~5 weeks per year
- Holiday Coverage: Required
- Location: Massachusetts LTSS Programs (UnitedHealthcare Community Plan of MA)
- Reports To: Chief Medical Officer
Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements.
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