Medical Director - Medicaid
Company: VirtualVocations
Location: Oceanside
Posted on: October 16, 2024
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Job Description:
A company is looking for a Medical Director - Medicaid to review
medical authorizations and claims for medical necessity.
Key Responsibilities
Review medical authorizations and claims to determine medical
necessity
Conduct discussions with external physicians to gather clinical
information
Oversee coding practices and clinical documentation, grievances,
and appeals processes
Required Qualifications, Training, and Education
Doctor of Medicine or Doctor of Osteopathy
Board-certified in an ABMS- or AOA-recognized specialty
At least five years of post-training clinical experience
Experience in utilization management review and case management in
a health plan setting
Active, unencumbered physician license in at least one state in the
Humana Medicaid national market
Keywords: VirtualVocations, Escondido , Medical Director - Medicaid, Executive , Oceanside, California
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