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 incen...
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 incen...