Medical Director - Spine
Core
Subject Matter Expert expanding medical management programs for spine care across the continuum of care.
Role type
Senior Medical Director (Spine)
Builds
Medical management programs and utilization review/quality assurance processes
Domain
Health Insurance / Orthopedic Spine & Neurosurgery
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Orthopedic Spine OR Neurosurgery expertise, post-graduate direct patient care experience, clinical quality assessment, utilization review, case management leadership, network provider liaison, predetermination reviews, claim determination reviews, coding expertise, reimbursement expertise
Preferred skills
Healthcare insurance experience
Technologies
Computer based applications
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, perform predetermination reviews and claim determinations
Seniority
Senior, hands-on IC