Massachusetts Licensed Medical Director - Salinas California

Company: VirtualVocations
Location: Salinas, California
Posted On: 01/22/2025

A company is looking for a Medical Director, Clinical Reviews to perform utilization management and provider payment reviews.



Key Responsibilities

Conduct clinical reviews of prospective, concurrent, and retrospective coverage requests
Communicate with providers and facilities to resolve clinical issues and support peer-to-peer discussions
Perform quality of care reviews and assist with credentialing for providers and facilities


Qualifications

Current unrestricted license as a medical or osteopathic doctor
Board-Certified MD or DO in an American Board of Medical Specialty
Minimum of five years of clinical experience
Experience in utilization management or quality management preferred
Understanding of utilization management and quality assurance principles More...

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