Upvote
Downvote
Associate Medical Director Parkland Community Health Plan
Share Job
- Suggest Revision
- Reviews requests for prior authorization and appeals for approval or denial of claims payment based on medical necessity.
- Supports the clinical activities of PCHP Utilization Management, Quality Management, Clinical Policy, Technology Assessment, Credentialing, Population Health and Fraud, Waste and Abuse Functions to assure comprehensive, high quality health care to plan members in accordance with managed care and PCHP policies.
- Must have successfully completed an Accreditation Council for Graduate Medical Education (ACGME) or American Medical Association (AMA) approved residency in an appropriate specialty to the PCHP population.
- Must understand and demonstrate knowledge of principles of care coordination and collaboration, population health and social determinants of health, clinical evaluation of evidence based care and value based purchasing.
- Reviews prior authorization and appeals request for approval or denial of claims payment based on medical necessity.
Active Job
Updated 4 days agoSimilar Job
Relevance
Active