Medical Director Medical Operations
New
G
Geisinger Health PlanHealthcare Managed Care
Work from home (Pennsylvania)Full-TimeDirector
Salary not disclosed
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Job Details
Requirements
- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
- Valid medical license to practice as a Medical Doctor in the State of Pennsylvania.
Responsibilities
- Lead medical management of all Health Plan inpatient activity, including acute inpatient, LTAC, observation, SNF, and rehabilitation.
- Develop and implement the Health Plan Medical Management Plan for inpatient services.
- Collaborate with other Medical Directors to manage medical goals within regional networks.
- Provide guidance on medical appropriateness, benefit application, and levels of care.
- Participate in Medical Director on-call duties and Appeals Committee activities.
- Administer the practitioner and provider appeals process alongside the Director of Medical Management.
- Manage medical director correspondence related to denials and appeals to ensure quality and accuracy.
- Contribute to the Plan Pharmacy and Therapeutics Committee.
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