Job Summary
A company is looking for a Medical Director - Medical Policy & Operations.
Key Responsibilities
- Provide clinical expertise and business direction for medical management programs
- Support clinical claim review processes, pre-certification, and appeals
- Analyze data to identify quality improvement opportunities in healthcare services
Required Qualifications
- Five or more years of experience in the Health Care Delivery System
- Active and current state medical license without encumbrances
- M.D. or D.O. with Board Certification in an ABMS recognized specialty
- Post-graduate direct patient care experience
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