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Highmark Health

Creating remarkable health experiences, freeing people to be their best.

Medical Director

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 10,001+Since 1852H1B SponsorCompany SiteLinkedIn

Location

Louisiana + 4 moreAll locations: Louisiana | North Carolina | Maryland | Pennsylvania | Washington

Posted

11 days ago

Salary

$227.6K - $385K / year

Seniority

Lead

Postgraduate Degree5 yrs expEnglish

Job Description

Medical Director

Highmark Health

• Conduct electronic review of escalated cases against medical policy criteria • Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned • Compose clear and concise rationales for member and provider determination notifications • Participate as a member of the CMDM multidisciplinary team • Advise multidisciplinary team on cases that require physician expertise • Actively manage projects and/or participate on project teams that require a physician subject matter expert

Job Requirements

  • Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
  • 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
  • 1 year in Medical Management in a Health Insurance Plan preferred
  • Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
  • Active medical state licensure required
  • Strong knowledge of managed care industry preferred

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