Remote Medical Director, Appeals
Core
Provide medical leadership for utilization management, cost containment, and quality improvement activities, including medical review of complex cases and appeals.
Role type
Senior Medical Director (Appeals & Utilization Management)
Builds
Utilization management programs, quality improvement initiatives, and provider network strategies
Domain
Healthcare administration, insurance, and utilization review
Required skills
Medical leadership, utilization management, medical review, quality improvement, provider network development, claims adjudication, regulatory compliance, physician education, committee management, trend analysis
Preferred skills
Health administration/financing knowledge, experience with diverse populations, Internal or Family Medicine certification
Technologies
None stated
Responsibilities
Direct medical management and credentialing functions, perform medical reviews for complex or controversial services, conduct rounds for high-risk patients, collaborate on medical necessity appeals, develop provider alliances, represent the business unit at state committees, identify adverse utilization trends, implement physician education programs
Seniority
Senior, hands-on IC