Medical Director(Neonatologist Preferred)
Core
Provide medical leadership and subject matter expertise for utilization management, care management, and quality of care programs for infant and neonatology services.
Role type
Senior Medical Director (Neonatology)
Builds
Utilization management, care management, and quality improvement programs for newborn and infant members.
Domain
Healthcare / Managed Care / Neonatology
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical case review, prior authorization medical reviews, peer-to-peer discussions, clinical appeals adjudication, fraud/abuse investigation, quality improvement initiatives, clinical policy development, NICU transition management, regulatory compliance, market strategy definition, community health system liaison.
Preferred skills
Managed care medical review experience, Business Administration or Healthcare Administration degree.
Technologies
Microsoft Word
Responsibilities
Work with Vice Presidents and Medical Directors to achieve utilization and quality objectives; provide training and clinical consultation to staff; participate in quality improvement and member safety activities; review utilization data to identify variances; develop clinical care standards and practice guidelines; collaborate on market strategy; support regulatory and accreditation functions.
Seniority
Senior, hands-on IC with strategic oversight