An established managed long-term care facility in New York is seeking a compassionate and dedicated individual, with a strong background in managed care insurance, for a promising opportunity on their staff as a Senior Medical Director. In this role, the Senior Medical Director will be responsible and accountable to the Chief Medical Officer for helping to manage health plan medical quality and costs, as well as ensuring appropriate health care delivery. Apply today!
The Senior Medical Director:
- Reviews cases, determines medical necessity, and consults with physicians, review length of stay and reimbursement documentation
- Supports Case Management/UM department staff and nurse case managers on concurrent review and pre-authorization referrals
- Ensures clinical services consistent with their benefits, regulatory requirements and established clinical criteria
- Provides clinical support for Member and Provider appeals
- M.D., D.O.
- Board Eligible / Certified
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