What are the responsibilities and job description for the Medical Director - Medicare Advantage position at Physician Pivot?
Overview The Infosys Healthcare unit is dedicated to transforming the healthcare industry by leveraging cutting-edge AI-driven solutions to simplify complexities and enhance patient experiences. We focus on creating connected ecosystems, optimizing operations, and delivering superior care across all touchpoints. Join us to be a part of a team that is at the forefront of healthcare innovation, driving down costs while improving patient outcomes.
In the assigned Job Role of Product Project Lead 2, your Area Of Responsibility will be as below:
Key Responsibilities
Clinical Leadership: Serve as the clinical leader for Medicare Advantage medical management programs.
Utilization Management & Appeals: Oversee utilization management activities, review and resolve complex clinical cases and appeals, and ensure timely and accurate coverage determinations.
Case Management & Population Health: Provide clinical oversight for all case management and population health programs.
Quality Improvement: Support and lead initiatives to improve quality performance, member experience, and health outcomes.
Regulatory & Accreditation Compliance: Ensure compliance with Medicare Advantage regulations and accreditation standards.
EEO Infosys provides equal employment opportunities to applicants and employees without regard to race; color; sex; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; status as a protected veteran or spouse/family member of a protected veteran; or disability.
In the assigned Job Role of Product Project Lead 2, your Area Of Responsibility will be as below:
- Define project scope, goals, and deliverables that support business goals in collaboration with internal and client stakeholders.
- Monitor project performance reports that provide insights into progress, challenges, and outcomes.
- Establish and maintain relationships with mid level and senior client stakeholders and provide update on sprint planning and project progress.
- Monitor and manage the product lifecycle by translating business needs into technical requirements, while defining product roadmap and driving development and quality assurance, aligning resources and schedules, and ensuring seamless delivery and deployment of scalable solutions for client engagements.
- Proactively identify potential risks and issues that could affect project success. Implement mitigation strategies for identified risks and collaborate with quality assurance teams to integrate quality planning into the core activities.
- Develop project estimates in line with project scope, approach, milestones and manage change requests.
- Monitor estimates v/s actuals and oversee the allocation and management of project resources, including personnel, technology, and budget, to maximize efficiency and effectiveness.
- Assist in preparing technical and commercial proposals for upcoming client engagements.
- Develop resource plans and define role requirements that anticipate future project needs and address potential shortages.
- Conduct performance appraisals for team members.
- Demonstration of strategic mindset for delivering impactful, client-aligned projects
- Problem-solving expertise and ability to run project economics and delivery
- Strong relationship with mid and senior level client stakeholders
- Strong leadership abilities to foster team performance and growth
- Commitment to cultivating a culture of learning and innovation
Key Responsibilities
Clinical Leadership: Serve as the clinical leader for Medicare Advantage medical management programs.
Utilization Management & Appeals: Oversee utilization management activities, review and resolve complex clinical cases and appeals, and ensure timely and accurate coverage determinations.
Case Management & Population Health: Provide clinical oversight for all case management and population health programs.
Quality Improvement: Support and lead initiatives to improve quality performance, member experience, and health outcomes.
Regulatory & Accreditation Compliance: Ensure compliance with Medicare Advantage regulations and accreditation standards.
- Must have MD or DO from an accredited medical school.
- Current unrestricted physician license in at least one U.S. state.
- Board certification in an ABMS or AOA-recognized specialty.
- Experience of post-residency clinical practice.
- Experience in managed care, Medicare Advantage, UM, or health plan operations.
- Strong clinical judgment and medical decision-making skills.
- Experience with Stars, HEDIS, Population Health, and Quality Improvement initiatives.
- Ability to lead multidisciplinary teams and collaborate across departments.
- Excellent communication and provider engagement skills.
- Strong analytical and problem-solving abilities.
- Bachelor’s degree or foreign equivalent required from an accredited institution. Will also consider three years of progressive experience in the specialty in lieu of every year of education.
- This position may require relocation and/or travel to work/project location.
- Candidates authorized to work for any employer in the United States without employer-based visa sponsorship are welcome to apply. Infosys is unable to provide immigration sponsorship for this role now or in the future.
- Medical/Dental/Vision/Life Insurance
- Long-term/Short-term Disability
- Health and Dependent Care Reimbursement Accounts
- Insurance (Accident, Critical Illness , Hospital Indemnity, Legal)
- 401(k) plan and contributions dependent on salary level
- Paid holidays plus Paid Time Off
EEO Infosys provides equal employment opportunities to applicants and employees without regard to race; color; sex; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; status as a protected veteran or spouse/family member of a protected veteran; or disability.