Medical Director
Core
Administer medical services, manage utilization review, and provide clinical consultation to ensure cost-effective care for national account clients.
Role type
Director-level Medical Director (Utilization Management)
Builds
Clinical operations and utilization management programs for large corporate health plans
Domain
Health Insurance / Utilization Management
Required skills
Utilization management, clinical operational guidance, peer-to-peer clinical reviews, medical policy interpretation, cost-of-care analysis, regulatory compliance, strategic advisory
Preferred skills
Health plan experience, hospital-based utilization review, Oncology review, Genetic Testing review, Pediatric review, Surgical review, Internal Medicine review
Technologies
None stated
Responsibilities
Conduct peer-to-peer clinical reviews with attending physicians, interpret medical policies and clinical guidelines, direct clinical activities impacting quality and cost, identify opportunities for innovation, represent the company to external clients, serve on internal and external committees, provide backup call coverage
Seniority
Director, strategic leadership with hands-on clinical oversight