This position also participates in the development of goals and objectives in accordance with company standards. Assures the development of staff leadership through the design of effective shared leadership models and supports career advancement opportunities. Functions as a role model and encourages staff to participate in their own development.
In this role, you will Work with the Regional Behavioral Health Authority (RBHA) medical staff to ensure administration and delivery of high quality, medically appropriate care including care by subcontracted providers.
Conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed in peer-to-peer telephone calls.
Develop policies and procedures, and standard operating procedures that will provide a consistent approach to clinical appeal medical director adjudication processes for the clinical appeal departments across all three business segments.