Medical Director overseeing clinical operations in post-acute care for Elevance Health. Responsible for medical necessity decisions and clinical case reviews, ensuring timely medical decisions.
Responsibilities
Ensures timely completion of clinical case reviews for their board certified specialty
Makes physician to physician calls to gather medical appropriate information
Makes medical necessity determinations for grievance and appeals appropriate for their specialty
Ensures consistent use of company medical policies when making medical necessity decisions
Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation
Requirements
Requires MD/DO
Board certification approved by ABMS or AOA
Must possess an active unrestricted medical license to practice medicine
Minimum of 1 year of experience with clinical case reviews for medical necessity
Board certification in a medical specialty required
3 years of clinical experience post residency preferred
Deputy Program Medical Director advancing quality, safety, and patient experience at Monash Health Radiology. Influencing strategic direction and leading clinical projects in a complex healthcare setting.
Medical Director with a vision to transform care for patients in Florida and Kentucky. Leading provider teams to ensure clinical excellence and comprehensive patient care.
Clinical Director overseeing treatment plans at Hickory Recovery Center. Responsible for implementing treatment strategies and supervising the clinical team while ensuring compliance.
Clinical Director leading care delivery across clinician teams in a fast - growing virtual women's health care company. Combines clinical leadership with direct patient care in a hybrid role.
Senior Global Medical Director leading global medical affairs plans for oncology. Driving strategic initiatives and collaborating with key stakeholders in the medical community.
Global Development Medical Director overseeing clinical strategies and safety monitoring for AstraZeneca's hemato - oncology projects. Ensuring compliance and high ethical standards in clinical studies.
Medical Director leading early clinical development in Immunology at Lilly, bridging discovery science and clinical application to drive transformational medicines.
CRM Medical Director at AstraZeneca responsible for CRM solutions for medical field engagement and compliance. Collaborating with medical field leaders to enhance productivity and user experience in CRM processes.
Medical Director managing clinicians' operations and utilization reviews across various states. Ensuring compliance with medical policies while enhancing healthcare quality and effectiveness.
Behavioral Health Medical Director responsible for behavioral health services for California Medicaid members. Reviewing cases and providing clinical consultation while ensuring quality care outcomes.