Medical Director - ENT
Core
Clinical Subject Matter Expert for Otolaryngology (ENT) providing guidance, oversight, and evidence-based decision-making for medical management programs.
Role type
Senior Medical Director (Clinical SME)
Builds
Medical management programs and clinical determination processes
Domain
Health Insurance / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Otolaryngology clinical expertise, utilization management, medical necessity review, prior authorization review, coding and reimbursement knowledge, medical policy development, interdisciplinary collaboration
Preferred skills
Health plan operations experience, case management partnership
Technologies
None stated
Responsibilities
Conduct utilization management and medical necessity reviews, support timely clinical determinations for members and providers, review prior authorizations and claim determinations, provide clinical expertise on coding and reimbursement, partner with case management teams, act as clinical liaison with network physicians and facilities
Seniority
Senior, hands-on IC with strategic oversight