Medical Director

• Responsible for working hand-in-hand with senior leaders to provide medical expertise and decision making within the Utilization Management team.
• Responsible for ensuring that healthcare services are medically necessary, appropriately utilized, and meet the highest standard of quality.
• Adhere to standard Federal, State and/or CMS compliant medical policies within the organization.
• Reviewing clinical cases, providing medical expertise, and collaborating with various stakeholders to ensure efficient and effective healthcare delivery.
• Maintaining accurate and thorough documentation of activities and decisions.
• Analyzes aggregate data and reports to primary care physician.
• Serves as the liaison between physicians and health plan Medical Directors.
• Participates in the Grievance and Appeal review process to provide recommendations.
• Identify process improvements opportunities and inefficiencies.

Part-Time Medical Director – Utilization Management

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