Medical Director

Job description

About The Role The Medical Director will be responsible in providing support to our commercial and worker’s compensation self-funded clients seeking cost effective resolution of their member’s claims. Your interest and help leading and developing our team and maturing the program only makes the opportunity more rewarding. We have been in business for 25 years and leading by example you will help create a culture focused on service, support of quality healthcare service, and medical cost containment for the benefit of our clients and their members. Primary Responsibilities: - Creates and updates medical policies and procedures in conjunction with associate medical directors and other clinical staff and assures consistency and compliance with generally accepted medical standards and guidelines. - Provides clinical support for all areas of Clinical Services. - Review medical files and make coverage and medical necessity determinations using good judgement combined with 3rd party and proprietary medical guidelines. - Identify, critique, and utilize criteria and resources such as national, state, and professional association guidelines and peer reviewed literature to support sound and o...