Appeals Medical Director- Cardiology
Core
Lead clinical and non-clinical activities to review physical health medical services appeals, ensuring cost-effective care and improving quality/outcomes.
Role type
Director-level Appeals Medical Director (Cardiology)
Builds
Utilization review and appeals programs for physical health services
Domain
Healthcare administration / Cardiology
Deliverable
client delivery
Required skills
Medical decision making, clinical policy interpretation, program development, cost analysis, strategic advising, committee leadership, innovation identification
Preferred skills
Cardiology board certification, utilization management experience, appeals process experience
Technologies
None stated
Responsibilities
Conduct peer-to-peer clinical case reviews with physicians, interpret medical policies and clinical guidelines, develop and propose new medical policies, lead clinical and non-clinical activities impacting quality and cost, serve as a resource and consultant for other areas, represent the company to external entities
Seniority
Director, hands-on leadership & strategy