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Medical Director - Medicaid

Company: VirtualVocations
Location: Oceanside
Posted on: October 16, 2024

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, El Cajon , Medical Director - Medicaid, Executive , Oceanside, California

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