Medical Director-Health Plan
Job ID #1979783
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About this Role
Responsible for the appropriateness and quality of care delivered and for cost-effective utilization of services.
Job details
$133.76 / hour
Remote, National
Profession: Medical Director
Facility Type: ???
Specialty: Health Plan
Division:
MedFi
Start Date: 12/17/2025
Responsibilities
Performs treatment authorization review to determine medical necessity, appropriateness of services, and interpret benefits and limitations. Reviews that care is consistent with the Plan’s standards of quality.
Participates in concurrent review activities of inpatient and long term care plans.
Reviews claims that are unusual in cost, volume or scope of services.
Coordinates with Directors of Medical Management and Quality Improvement to provide daily support and appropriate direction to staff on issues pertaining to UM and QI.
Assists in developing and revising policies to support utilization management activities, including criteria and guidelines for the appropriate use of services clinical practice guidelines, and treatment guidelines.
Required Qualifications
Licensed in GA or Compact License (IMLC)
UM experience