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Medical Director - Southwest Medicaid
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- Work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management, with clinical scenarios arising from outpatient, inpatient, or post-acute care environments
- Oversees coding practices and clinical documentation, grievance, and appeals processes (including pharmacy), and conducts reviews for durable medical equipment (DME), genetic testing, etc.
- May speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes and a focus on collaborative business relationships, value-based care, population health, or disease or care management
- Experience in utilization management review and case management in a health plan setting
Expired 8 days agoInactive Job
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