Medical Director

• Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet applicable medical necessity guidelines
• Review imaging requests when providers, clients, or state laws require specialty reviews by the subject matter expert
• Discuss determinations (peer to peer phone calls) with requesting physicians or ordering providers within the regulatory timeframe
• Utilize medical/clinical review guidelines and parameters to assure consistency and compliance with SBU policies/procedures, URAC, and NCQA guidelines
• Provide clinical rationale for standard and expedited appeals
• Ensure documentation of all communications with medical office staff and/or MD providers is recorded timely and accurately
• Participate in ongoing training per inter-rater reliability process
• May function as Medical Director for selecting health plans or regions on request, working with the Senior Medical Director
• May assist the Senior Medical Director in research activities/questions
• Routinely interact with leadership and management staff, other Physicians, and staff; aid and act as a resource to Initial Clinical Reviewers

Field Medical Director, Pain Management

Medical Director, Safety Evaluation – Risk Management, Neuromuscular

Regional Medical Director

Clinical Director

Medical Director – IP Claims Management

Area Medical Director