In this role, the selected candidate will provide direction and acts as a resource to the Multidisciplinary team to discuss individual member care management gaps, interventions and collaboration with Providers and Specialists.
The Medical Director is responsible for providing clinical expertise, oversight for medical policy implementation and business direction in support of the development, implementation, and evaluation of clinical/medical programs to promote the delivery of high quality, constituent responsive medical care.
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.
The Medical Director (MD) is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive medical care.
In this role, the selected candidate will be responsible for performing medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
In this role, the candidate will oversee the hiring, reviewing, disciplining and terminating of professional staff, in accordance with and with the approval of the Regional Medical Director or Group Vice President.
In this role, the selected candidate will 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.