Medical Director

• Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received.
• Develops and implements programs to improve quality, cost, and outcomes.
• Provides clinical consultation and serves as clinical/strategic advisor to enhance clinical operations.
• Identifies cost of care opportunities.
• Serves as a resource to staff including Medical Director Associates.
• May be responsible for an entire clinical program.
• 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 to discuss review determinations, and patients’ office visits with providers and external physicians.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
• Interprets medical policies and clinical guidelines.

Medical Director

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Associate Medical Director

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