Senior Medical Director (Medicare)

Job description

JOB DESCRIPTION Job Summary Uses leadership and/or equivalent specialty expertise (transplant, genetics, etc.) to provide advanced clinical managed care / clinical performance. May lead and manage a team of medical directors delivering oversight and expertise in appropriateness and medical necessity of services provided to members - ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties: - Provides leadership and expertise in advanced clinical performance of prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT) activities. - May lead a team of medical directors responsible for assessing appropriateness and medical necessity of health care services provided to plan members. - Recruits, hires, trains, mentors and develops medical director staff as needed. - Ensures that authorization decisions are rendered by qualified medical personnel and without hindrance due to fiscal or administrative incentives. - Analyzes data and identifies medical cost-savings and quality improvement opport...