Medical Director - Post Acute Care
Core
Board-certified physician providing medical necessity determinations, clinical case reviews, and appeals/grievance decisions for post-acute care services.
Role type
Clinical Operations Medical Director (Post Acute Care)
Builds
Medical necessity decisions and clinical case reviews for post-acute care benefit utilization management
Domain
Healthcare / Post Acute Care / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Board certification in a medical specialty, Active unrestricted medical license, Clinical case review experience, Physician-to-physician communication, Policy interpretation
Preferred skills
Board certification in Physical Medicine and Rehabilitation
Technologies
None stated
Responsibilities
Ensuring timely completion of clinical case reviews, Making physician-to-physician calls for medical necessity determinations, Making medical necessity determinations for grievances and appeals, Ensuring consistent use of company medical policies, Escalating complex cases requiring Medical Director review
Seniority
Individual Contributor, Clinical Expert