Medical Director managing clinicians' operations and utilization reviews across various states. Ensuring compliance with medical policies while enhancing healthcare quality and effectiveness.
Responsibilities
Supports clinicians to ensure timely and consistent responses to members and providers.
Provides guidance for clinical operational aspects of a program.
Conducts peer-to-peer clinical reviews with attending physicians or other providers.
Serves as a resource and consultant to other areas of the company.
Interprets medical policies and clinical guidelines.
Identifies and develops opportunities for innovation to increase effectiveness and quality.
Requirements
Requires MD or DO and Board certification approved by ABMS or AOA
Must possess an active unrestricted medical license to practice medicine
Minimum of 10 years of clinical experience, or equivalent combination of education and experience
For Health Solutions and Carelon organizations, minimum of 5 years experience providing health care required.
General Surgeon or Primary Care specialties preferred.
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