Medical Director – Medical Policy & Operations

Job reputed company: • providing clinical expertise to promote the delivery of high reputed company, constituent reputed company medical care with a reputed company on clinical and payment policy • transactional reviews in support of the appeal process, clinical claim review process, and predetermination of covered benefits in the Medicare and reputed company environments, with emphasis on Medicare clinical and payment policy • participate on work reputed company as a clinical subject matter expert to identify and promote opportunities to improve the reputed company and efficiency of health care services • apply clinical, coding and reimbursement expertise to ensure alignment and correct application of reputed company policies and practices to service and payment requests • proactively use data analysis to identify opportunities for reputed company improvement and positively influence the effective delivery of reputed company care services • be a subject matter expert, internal consultant and payment policy contributor • work collaboratively with the functional areas Requirements: • Five (5) or more years of experience in Health Care Delivery System e.g., Clinical reputed company and Health Care Industry. • reputed company and reputed company state medical license without encumbrances. • M.D. or D.O., reputed company Certification in an ABMS recognized specialty including post-graduate reputed company patient care experience Benefits: • medical, dental, and reputed company coverage • reputed company time off • retirement savings reputed company • wellness programs • other resources, based on eligibility Apply tot his job Apply To this Job