Medical Director - Commercial
Core
Develop, implement, and evaluate clinical/medical programs to expand medical management and address member needs across the continuum of care.
Role type
Senior clinical leader (Medical Director) in medical management
Builds
Medical management programs and clinical care pathways
Domain
Health insurance / Managed care
Required skills
Clinical expertise, medical program development, prior authorization management, provider liaison, appeals management, business direction for clinical teams
Preferred skills
Managed care experience, electronic medical record systems, board certification in Internal Medicine/Family Medicine/Emergency Medicine/Surgery
Technologies
Electronic medical record systems
Responsibilities
Develop and evaluate clinical/medical programs; support Medical Management staff with member and provider responses; manage Prior Authorization, Pre-Certification, Concurrent Reviews, Peer-to-Peer calls, and First Level Appeals; act as lead business and clinical liaison to network providers
Seniority
Senior, hands-on IC with strategic oversight