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.
The Medical Director attends to patients, provides medical consultations for the medical staff and institutional officials, and functions as the liaison for clinical matters with medical providers outside the institution.
The Director Emergency Services Department assures service, growth, development, personnel management, and resource allocation and management controls in order to ensure consistent high-quality patient care in the Emergency Department.
Establishes and maintains standards for the mental health services team members, with focus on quality of patient care and service, accessibility to clients, client retention, and productivity of team members.
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.