Medical Director

Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. Active and current medical license without encumbrances M.D. or D.O., Active and Current Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience. AZ medical license without encumbrances

Provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical / medical programs and expand medical management programs to address member needs across the continuum of care. Support the Medical Management staff ensuring timely and consistent responses to members and providers. Overseeing utilization review and quality assurance while being responsible for predetermination reviews and review of claim determinations. Provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities. Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. Participate in a weekend, holiday and on-call rotation.