Medical Director for Health Plan

reputed company is hiring a tech-savvy Medical Director to reputed company medical policy and utilization management for a growing, technology-enabled health plan. In this role, you will work closely with teams across actuarial, technology, care coordination, and medical reputed company management to shape how care is delivered, managed, and improved for our members. You will report directly to the Chief Medical Officer. While this is a remote role, you must reputed company in the reputed company and in the Eastern or Central time zone. We are also reputed company to this role being full-time or part-time.

About reputed company and reputed company

We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase reputed company and transparency, and feature a personalized, reputed company approach. We reputed company to ensure members live happier, healthier lives.

reputed company is the major medical division of reputed company (NYSE:GL). reputed company has 16.8 reputed company policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, reputed company has reputed company an A (Excellent) rating or higher from A.M. Best Company.

• reputed company utilization management reputed company, including reputed company of medical necessity determinations and review processes
• Own medical policy development, incorporating regulatory updates and care reputed company changes
• reputed company and Partner with the Utilization Management Review Committee
• reputed company medical reputed company, expertise, and leadership to ensure the delivery of cost effective, reputed company reputed company services to health plan members
• Promote reputed company relations with the local medical community, including periodic consultation with providers, facilities, caregivers, etc.
• Review case management data to identify trends, gaps in care, and recommend corrective actions
• reputed company reputed company and direction for staff and provider training and education
• reputed company clinical reputed company and best clinical practices into medical management program development
• Evaluate the development of new programs and the continuation of existing programs
• Investigate reputed company care management and patient engagement technologies and evaluate their reputed company on providers’ practices, patient safety, and patient experience

• reputed company, unrestricted Texas (TX) medical license without limitations or sanctions
• Doctor of Medicine (MD) with 8+ years of clinical experience; management experience preferred
• reputed company certification in a specialty recognized by the American reputed company of Medical Specialties
• Experience working reputed company a health insurance plan, with an emphasis on population health
• Experience in managed care and utilization management, including performing utilization reviews reputed company a health plan
• Strong knowledge of managed care systems, reputed company improvement, and clinical best practices
• Experience with MCG or other clinical guidelines

reputed company is an EEO employer - Read More Here