Medical Director - Radiation Oncology - MD or DO
Core
Oversees utilization review, quality assurance, prior authorization, and claim determinations for radiation oncology services within a health plan/payer setting.
Role type
Senior Medical Director (Radiation Oncology)
Builds
Medical management programs and clinical policies for oncology care
Domain
Healthcare / Radiation Oncology / Managed Care
Deliverable
dashboards & analysis
Required skills
Radiation oncology clinical expertise, utilization review, quality assurance, prior authorization, peer-to-peer appeals, medical policy implementation, case management, coding, reimbursement expertise
Preferred skills
Prior UM experience with a Health Plan/Payer, experience as a Physician Advisor in a Health/Hospital system
Technologies
None stated
Responsibilities
Oversee utilization review and quality assurance; conduct predetermination reviews and claim determinations; provide input for medical policy implementation; manage prior authorization, pre-certification, concurrent reviews, and first-level appeals; support medical management staff with timely responses to members and providers; act as a liaison to network providers and facilities
Seniority
Senior, hands-on IC