Medical Director

• Administration of physical and/or behavioral health medical services to ensure appropriate and cost-effective medical care
• Develop and implement programs to improve quality, cost, and outcomes
• Provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations
• Identify cost of care opportunities
• Serve as a resource to staff including Medical Director Associates
• May be responsible for an entire clinical program
• Support clinicians to ensure timely and consistent responses to members and providers
• Provide guidance for clinical operational aspects of a program
• Conduct peer-to-peer clinical reviews and peer-to-peer clinical appeal case reviews with attending physicians or other providers
• Serve as a resource and consultant for other areas of the company
• Represent the company to external entities and/or serve on committees; may chair committees
• Interpret medical policies and clinical guidelines and develop new medical policies based on changes in healthcare
• 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

Medical Director, OBGYN or Pediatric Specialty

Medical Director – Nat’l OP Medicare

Medical Director – Commercial

Senior Medical Director

Director of Clinical Operations

Clinical Director