Job Details

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements Engage with requesting providers as needed in peer-to-peer discussions Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews Participate in daily clinical rounds as requested Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy Communicate and collaborate with other internal partners Participate in holiday and call coverage rotation Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your rol...Medical Director, Director, Management, Medical, Remote, Health, Healthcare