Medical Director
Core
Administer physical and/or behavioral health medical services to ensure cost-effective care, developing programs to improve quality, cost, and outcomes.
Role type
Director-level Medical Director (Utilization Management)
Builds
Clinical programs and utilization review processes for health plan members
Domain
US Healthcare / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical licensure, Board certification, 10+ years clinical experience, clinical policy development, program management, peer-to-peer clinical reviews, cost of care analysis
Preferred skills
Utilization Management experience
Technologies
None stated
Responsibilities
Guide clinical operational aspects of a program, conduct peer-to-peer clinical reviews and appeals, interpret and develop medical policies, lead clinical and non-clinical activities impacting quality and cost, represent the company to external entities
Seniority
Director, hands-on program leadership