Medical Director - Orange

Only for registered members Orange, United States

1 day ago

Default job background
Full time $250,000 - $300,000 (USD)

Job summary

The Medical Director is responsible for actively participating in the review process of pre-service requests for services and following guidelines in the approval of those services or making recommendations for other determinations to the provider/vendor (denial/modification/redirection). The role will cooperate with and support other physician reviewers nurses and Medical Directors by knowing all processes and procedures while working to deliver excellent care cost-effectively based on medical management referral processing guidelines.
The Medical Director will be detail-oriented and able to research successfully evaluate often-complex clinical information to help formulate decisions communicate with members providers and internal users.

Responsibilities

  • Understand promote manage principles of medical management to facilitate right care patients at right time right setting.
  • Participate in pre-service medical necessity review patient care as part team medically directors nurses coordinators.

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