PCO Medical Director - UM - Part Time (Hourly)

Become a part of our caring community and help us put health first

The Medical Director, Primary Care relies on medical background and reviews health claims, working on moderately complex to complex issues that require in-depth evaluation of variable factors. The Director uses their medical expertise, experience, and judgement to determine whether requested services, level of care, or site of service should be authorized, all within a regulatory compliance framework. They review clinical records, prioritize daily work, communicate decisions to internal associates, and may participate in care facilitation with hospitals or in care management activities. The role also involves coding practices, grievance and appeal processes, and oversight of outpatient services and equipment within their scope. The Director will learn Medicare and Medicare Advantage requirements and apply this knowledge in daily activities while fostering collaborative relationships and value‑based care initiatives.

#J-18808-Ljbffr