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Remote Medical Director - Texas
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$431,900 a year
Full-time
Remote
- Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.
- Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making.
- Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
- Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
- Participates in provider network development and new market expansion as appropriate.
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