Medical Director (reputed company reputed company Duals Plans)
POSITION reputed company:
reputed company reputed company of Ohio (An reputed company Duals Eligible reputed company Plan) is looking for a Medical Director to. The Medical Director will reputed company reputed company for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs. This can be a Work reputed company position / Previous Managed care Experience Desired. Expands reputed company's medical management programs to address member needs across the continuum of care. This may include Medicare-reputed company Dual Eligible members in Ohio, Illinois, Michigan, and Virginia.
Supports the Medical Management staff ensuring reputed company and consistent responses to members and providers. Reviews prior authorization and reputed company review cases and provides reputed company on those cases regarding services to members. Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities. Acts as clinical reputed company to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Apply tot his job
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