Appeals Medical Director - Urology

Responsibilities Responsible for appeal reviews for physical health medical services Ensure appropriate and cost‑effective medical care is received May develop and implement programs to improve quality, cost, and outcomes Provide clinical consultation and serve as clinical/strategic advisor Identify cost of care opportunities Supports clinicians for timely and consistent responses to members and providers Provides guidance for clinical operational aspects of a program Conduct peer‑to‑peer clinical case reviews Serves as a resource and consultant for other areas of the company May represent the company to external entities and serve on committees Interprets medical policies and clinical guidelines May develop and propose new medical policies Leads, develops, directs, and implements clinical and non‑clinical activities Requirements MD or DO required Board certification approved by ABMS or AOA Must possess an active unrestricted medical license Minimum of 10 years clinical experience For Health Solutions and Carelon, minimum of 5 years experience providing health care is required Additional experience may be required by State contracts or regulations #J-18808-Ljbffr Jobtailor