Medical Director Medical Operations- Geisinger Health Plan
Core
Lead medical management for all Health Plan inpatient activity including acute care, LTAC, observation, SNF, rehab, and ambulatory surgery within a regional network.
Role type
Senior Medical Director (Medical Operations)
Builds
Health Plan Medical Management Plan for inpatient services
Domain
Healthcare / Health Insurance / Inpatient Care Management
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Inpatient care management, Medical Management Plan development, Regional network leadership, Claims audit support, Evidence of Insurability process, Home Health/DME guidance, Medical appropriateness interpretation, Appeals process administration, Pharmacy and Therapeutics Committee participation
Preferred skills
None stated
Technologies
None stated
Responsibilities
Lead medical management of inpatient activity (acute, LTAC, observation, SNF, rehab, ambulatory surgery), Develop and implement Health Plan Medical Management Plan for inpatient services, Collaborate with regional Medical Directors to manage medical goals, Support retrospective claims audit and claims check, Guide Home Health nurses on DME, Home Health, and Rehabilitation issues, Provide guidance on medical appropriateness and benefit application, Ensure proper documentation of paperwork within timelines, Participate in On-Call, On-Duty, and Appeals Committee activities, Administer practitioner and provider appeals process, Manage correspondence related to denials and appeals, Participate on Plan Pharmacy and Therapeutics Committee
Seniority
Senior, hands-on IC