Medical Claims Review Medical Director - Eden Prairie, MN
2 weeks ago
Job summary
We are looking for a Medical Director to provide physician support to Enterprise Clinical Services operations. The Medical Director will collaborate with Enterprise Clinical Services leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members.The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on post-service benefit and coverage determination or medical necessity (according to the benefit package),
and on communication regarding this process with both network and non-network physicians,
as well as other Enterprise Clinical Services.
Responsibilities
Job description
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