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Medical Director – Clinical Ops Case Review
Location
Alabama + 17 moreAll locations: Alabama | Arizona | Florida | Illinois | Iowa | Kansas | Kentucky | Nebraska | North Dakota | Oklahoma | Michigan | Minnesota | Missouri | South Dakota | Tennessee | Texas | Virginia | Wisconsin
Posted
3 days ago
Salary
$235.6K - $319.8K / year
Seniority
Lead
Job Description
Medical Director – Clinical Ops Case Review
Medica
• support care management, quality, utilization management, credentialing, pharmacy, health policy implementation, technology assessment and risk management activities • Completes care management case review for cases involving medical necessity review • Completes appeal case review for cases involving medical necessity review • Partners to establish priorities as appropriate for improving service at the point of care • Completes quality of care complaint reviews for cases involving clinical aspects or clinical/service aspects • Participates in rotation to above Committee Participation
Job Requirements
- Medical Doctorate (MD) or Doctor of Osteopathic Medicine (DO)
- 10+ years of experience beyond degree
- 5+ years of leadership experience
- Must be a licensed physician with current Board certification of ABMS recognized specialty
- Current medical license to practice must be without restrictions
- Must be willing and able to successfully apply for medical license in other states as needed
Benefits
- competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees
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