Part Time Medical Director (MD) – Case Management

Medical Director – Job Description

Organization: Pathwise Case Management, LLC
Location: Remote / Georgia-based (preferred)
Reports To: CEO / Administrator

About Pathwise Case Management

Pathwise Case Management provides nurse-led, telephonic case management, chronic care management, and care coordination services designed to improve patient outcomes and reduce healthcare costs. The organization partners with health plans to deliver high-quality, patient-centered interventions, including transitions of care and population health support.

Position Summary

The Medical Director provides clinical leadership, oversight, and strategic guidance to ensure the delivery of high-quality, evidence-based case management services. This role supports regulatory compliance, quality improvement, and collaboration with health plan partners while enhancing clinical outcomes for high-risk populations.

Key ResponsibilitiesClinical Oversight & Quality

• Provide medical oversight for all case management and care coordination programs
• Ensure services align with evidence-based guidelines, CMS, Medicaid, and payer requirements
• Review complex or high-risk cases and provide clinical direction to RN case managers
• Support development of care pathways, protocols, and clinical policies

Utilization & Population Health

• Guide utilization management strategies to ensure appropriate, cost-effective care
• Assist in reducing avoidable hospitalizations and readmissions
• Support risk stratification and population health initiatives

Regulatory & Compliance

• Ensure compliance with HIPAA, CMS, Medicaid, and state regulations
• Participate in audits, accreditation processes, and quality reviews
• Oversee clinical documentation standards and medical necessity criteria

Collaboration & Leadership

• Serve as clinical liaison with health plans, providers, and community partners
• Collaborate with leadership on program development and expansion
• Provide clinical education and mentorship to nursing staff

Quality Improvement & Outcomes

• Lead quality improvement initiatives (HEDIS, STAR measures, etc.)
• Monitor key performance indicators (KPIs) such as readmission rates and engagement
• Support data-driven decision-making and reporting

QualificationsRequired

• MD or DO with active, unrestricted license (Georgia preferred)
• Board certification in Internal Medicine, Family Medicine, or related field
• Minimum 3–5 years of clinical experience
• Experience in managed care, case management, or population health

Preferred

• Experience with Medicaid and/or Medicare Advantage populations
• Background in utilization management or quality improvement
• Familiarity with telehealth and remote care models
• Leadership experience in care coordination programs

Core Competencies

• Strong clinical judgment and decision-making
• Knowledge of care coordination and chronic disease management
• Understanding of payer models and value-based care
• Excellent communication and collaboration skills

Work Structure (Typical for Your Model)

• Part-time or contract role (e.g., 5–10 hours/month or as needed)
• Remote with periodic case review meetings
• Available for consultation on complex cases

Why This Role Matters at Pathwise

This position ensures that Pathwise maintains:

• High-quality, compliant clinical services
• Strong outcomes for health plan partners
• Credibility and oversight required for contracts and audits

Compensation & Structure
This role is intentionally designed as a high-leverage clinical leadership opportunity requiring minimal active time. It is ideal for physicians looking to generate meaningful additional income while maintaining full flexibility in their schedule.

Compensation is competitive and scalable, typically ranging from $2,000 to $8,000+ per month, depending on portfolio size and level of involvement. Detailed compensation structure is shared during the interview process.

Work Location: Remote