Medical Director (Part-Time)

ESSENTIAL DUTIES and RESPONSIBILITIES:   The Medical Director relies on their medical background to review claims for medical necessity for prior authorization, continued stay review and post service. The Medical Director can read, interpret, and apply medical policy, guidelines, and research to utilization review. The Medical Director has authority for issuing adverse determinations while performing medical necessity evaluation.   - Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances, these may require conflict resolution skills. Some roles include an...