About this role
Job title: Medical Director
About the Role The Medical Director provides physician support to Enterprise Clinical Services operations, focusing on the initial clinical review of service requests and utilization management. The role collaborates with Enterprise Clinical Services leadership to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement, and cost effectiveness of service for members. Activities center on applying clinical knowledge to utilization management with emphasis on pre-service benefit and coverage determinations or medical necessity, and communicating this process with network and non-network physicians and other Enterprise Clinical Services. The Medical Director works with a multidisciplinary team and is involved in managing medical benefits, often coordinating with the member’s primary care provider or specialist. The primary responsibility is to ensure appropriate and cost-effective, high-quality medical care for members. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.