Medical Director

• Support the Medical Management staff ensuring timely and consistent responses to members and providers
• Lead all aspects of utilization review/quality assurance, directing case management
• Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities
• Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams
• Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise

• 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry
• Active and current state medical license without encumbrances
• M.D. or D.O., Board Certification in an Orthopedic specialty including post-graduate direct patient care experience specifically

Previous healthcare insurance experience

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs including wellness screenings, tobacco cessation and weight management programs, confidential counseling, and financial coaching
• Benefit solutions depending on eligibility including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, and retiree medical access