Medical Director

• Lead medical management of Health Plan inpatient activity, including acute inpatient, LTAC, observation, SNF, rehabilitation, and ambulatory surgery
• Develop and implement the Health Plan Medical Management Plan for inpatient services
• Collaborate with Health Plan Medical Directors to manage medical goals in each region
• Collaborate with Medical Directors for Medical Home and Informatics to implement and monitor the Medical Management Plan
• Support retrospective claims audits and claims checks
• Support Evidence of Insurability and Over Age Dependent processes
• Support Geisinger Home Health nurses on DME, Home Health, and rehabilitation issues
• Provide guidance on medical appropriateness, benefit application, level of care, and out-of-network care
• Ensure complete and timely documentation
• Participate in Medical Director On-Call, On-Duty, and Appeals Committee activities
• Administer the practitioner and provider appeals process
• Ensure quality, accuracy, and timely completion of correspondence related to denials and appeals
• Participate on the Plan Pharmacy and Therapeutics Committee

Medical Director jobs in Pennsylvania

Medical Director – Medical Operations