Senior Medical Director (IPA- Based in CA)

Job description

JOB DESCRIPTION Job SummaryLeads and manages 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. Position is based in California. Essential Job Duties: - Leads a team of medical directors responsible for assessing appropriateness and medical necessity of health care services provided to plan members. - Provides leadership and expertise in performance of prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT) activities. - 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 opportunities. - Accounts for regulatory and accreditation performance of assigned team and responds to inquiries, issues and complaints from gove...