Medical Director

• The Manager Medical Director administers medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost-effective medical care is received and for the day-to-day management of medical management staff.
• Interpret existing policies and develop new policies based on changes in the healthcare or medical arena.
• Lead, develop, direct and implement clinical and non-clinical activities that impact health care quality cost and outcomes.
• Identify and develop opportunities for innovation to increase effectiveness and quality.
• Serve as a resource and consultant to other areas of the company.
• May chair or serve on company committees.
• May be required to represent the company to external entities and/or serve on external committees.
• Conduct peer clinical and/or appeal case reviews along with peer-to-peer clinical reviews with attending physicians or other ordering providers.
• Discuss review determination, provide guidance for clinical operational aspects of the program.
• Support the medical management staff ensuring timely. Consistent responses to members and providers.
• Hires, trains, coaches, counsels, and evaluate performance of direct reports.
• Directly supervises the management of any assigned staff.

Manager Medical Director

Medical Director – Nat’l OP Medicare

Medical Director – Commercial

Senior Medical Director

Director of Clinical Operations

Clinical Director