Senior Medical Director (Based in WA)

JOB DESCRIPTION Job Summary

Uses leadership and/or equivalent specialty expertise (transplant, genetics, etc.) to provide advanced clinical managed care / clinical performance. May lead and manage a team of medical directors delivering oversight and expertise in appropriateness and medical necessity of services provided to members - ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care.

Position is based in WA

Essential Job Duties

• Provides leadership and expertise in advanced clinical performance of prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT) activities.
• May lead a team of medical directors responsible for assessing appropriateness and medical necessity of health care services provided to plan members.
• Recruits, hires, trains, mentors and develops ...