Job Details

Provide daily utilization oversight and external communication with network physicians and hospitals Daily UM reviews - authorizations and denial reviews Conduct peer to peer conversations for the clinical case reviews, as needed Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care Communicate effectively with network and non-network providers to ensure the successful administering of Care Transitions services Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers Represent Care Transitions on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers Contribute to the development of action plans and programs to implement strategic initiatives and tactics...Medical Director, Management, Director, Acute Care, Medical, Remote