Medical Director -Spine
Core
Subject Matter Expert expanding medical management programs for spine care across the continuum of care, supporting utilization review, quality assurance, and clinical team activities.
Role type
Senior Medical Director (Spine)
Builds
Medical management programs and utilization review/quality assurance processes
Domain
Health Insurance / Orthopedic Spine / Neurosurgery
Deliverable
dashboards & analysis
Required skills
Board Certification in Orthopedic Spine or Neurosurgery, Post-graduate direct patient care experience, Clinical expertise in utilization review, Quality assurance leadership, Network provider liaison, Claim determination review
Preferred skills
Healthcare insurance experience
Technologies
Computer based applications for claims and coding
Responsibilities
Expand medical management programs to address member needs, Support Medical Management staff with timely responses, Lead utilization review and quality assurance, Act as clinical liaison to network providers, Provide clinical expertise for predetermination reviews and claim determinations
Seniority
Senior, hands-on IC