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Medical Review & Appeals Director (Hybrid)
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$150
Full-time
- Ensures alignment with the overall Corporate Strategic Plan through direction of the Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. May lead our Commercial team and our Government Programs (Medicaid and Medicare) team.
- We are looking for an experienced people leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model.
- Directs the Medical Review and Appeals units and manages multiple strategic clinical projects that span organizational boundaries, responsible for management of corporate care cost directives and goals.
- Provides direction and support for Corporate Compliance, including acting as a consultant to the Legal/Sales/Government Affairs/Compliance/Executive Inquiry Teams.
- 3 years' experience leading in a managed care or health insurance environment with a focus on Clinical Medical Review and Appeals and Grievances.
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