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Medical Director, Behavioral Health
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- External Provider Relations and Provider payment reviews including payment integrity
- The position will report directly to the Vice President and Senior Medical Director in the Office of the CMO and will work closely with vice presidents and directors throughout the organization.
- They will also work with other departments including Claims Operations, Actuarial, and Quality Management and could assist with performing clinical reviews of provider claims payment disputes, perform retrospective claims audits of medical records, review of potential quality of care issues as well as credentialing of Providers and Facilities.
- Work with Directors and other leaders and inform strategies to meet Accreditation Goals, HEDIS performance metrics, PIPs QIPS to improve quality of care and meet performance goals.
- Voting member of Committees like Appeals, Medical Technology and Medical Policy Approval, to help inform organization’s decisions for benefit coverage.
Expired 18 days agoInactive Job
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