Medical Director- North Carolina Medicaid
Core
Medical Director responsible for utilization review case management, quality improvement, and clinical operations for North Carolina Medicaid.
Role type
Director-level licensed physician (utilization review & clinical operations)
Builds
Utilization review programs, clinical policies, and operational strategies for Medicaid members and providers
Domain
US Healthcare / Medicaid / Utilization Review
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Utilization review, clinical case management, peer-to-peer reviews, medical policy interpretation, clinical operations leadership, cost of care analysis, program development
Preferred skills
Internal/Family/Emergency/OB/GYN medicine, Managed Care experience, Georgia medical licensure
Technologies
None stated
Responsibilities
Conduct peer-to-peer clinical reviews and appeals with providers, interpret and develop medical policies, lead clinical and non-clinical activities impacting quality and cost, serve as clinical advisor to operations, represent company to external entities
Seniority
Director, hands-on leadership