Apply📍 United States of America
💸 174070.0 - 374920.0 USD per year
🔍 Health Care
- 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.
LeadershipBusiness DevelopmentPeople ManagementCommunication SkillsAnalytical SkillsCollaborationProblem SolvingCustomer serviceAttention to detailOrganizational skillsWritten communicationComplianceInterpersonal skillsTeamworkVerbal communicationReportingTrainingActive listeningStrong communication skillsRelationship managementQuality AssuranceRisk Management
Posted 12 days ago
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