Medical Director

• The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized.
• Reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services.
• Regular discussions with external providers by phone to gather additional clinical information and discuss determinations.
• Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services.
• Maintain accountability for productivity, quality, and compliance metrics.
• Communicate determinations clearly both verbally and in writing.
• Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices.

Medical Director – National UM Team, Alternate Weekends

Medical Director, Safety Evaluation – Risk Management, Neuromuscular

Regional Medical Director

Clinical Director

Medical Director – IP Claims Management

Medical Director – Scientific Affairs