Medical Director

• As a Medical Director, you will use your clinical expertise to evaluate clinical service requests, interpret benefit language and medical policies, and render coverage determinations.
• Conduct clinical coverage reviews using member benefits and established clinical guidelines.
• Interpret benefit language and policies to support review determinations.
• Document review findings in accordance with regulatory, accreditation, and internal standards.
• Engage in peer-to-peer discussions with treating providers when needed.
• Collaborate with a nationwide team of Medical Directors.

Medical Director – Utilization Review

Clinical Director

Medical Director – IP Claims Management

Medical Director – Scientific Affairs

Medical Director, Appeals

Inpatient Medical Director