Medical Director
Core
Administer medical services, develop programs to improve quality and cost, and provide clinical consultation to enhance clinical operations.
Role type
Senior IC medical director (utilization management)
Builds
Clinical programs and medical policies for healthcare members and providers
Domain
US Healthcare / Utilization Management
Required skills
Medical administration, clinical operational guidance, peer-to-peer clinical reviews, policy interpretation, program leadership, cost of care analysis, committee chairing, innovation identification
Preferred skills
Utilization management experience, MCG/Carelon/Anthem criteria knowledge, Oncology review, Genetic Testing review, Musculoskeletal review
Technologies
MCG, Carelon, Anthem criteria
Responsibilities
Support clinicians for timely responses to members and providers; Conduct peer-to-peer clinical reviews with physicians; Interpret and develop new medical policies; Lead clinical and non-clinical activities impacting quality and cost; Provide evening and weekend coverage on rotation
Seniority
Director, hands-on IC