In this role, you will be responsible for
strong leadership, communication, written and negotiation skills required. Ability to manage change essential. Must be able to focus on priorities independently. Comfort with conflict management.
The Senior Medical Director/Care Management works actively to administer medical policies, care and disease management programs to ensure accessible, affordable and quality care to members in compliance with our regulatory agencies and contracted government customers.
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.
In this role, you will establish and maintain 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.
assume accountability and responsibility for orienting new staff to specific job duties with particular focus on safety and infection control; maintain current knowledge regarding disaster/hurricane preparedness/emergency management.