What are the responsibilities and job description for the Senior Medical Director position at Avalon Executive Search?
Position Summary : Our health plan client is seeking a Senior Medical Director to lead clinical utilization review efforts, manage pre-authorizations, and oversee claims. The role reports to the Chief Medical Director and will also work closely with medical directors, establish clinical guidelines, and manage data analytics to improve care quality and cost-efficiency. As a key community leader, you'll actively engage with provider partners and regulatory agencies to support strategic goals.
Responsibilities :
- Manage a team of Medical Directors
- Lead clinical utilization reviews and oversee pre-authorizations.
- Provide medical expertise for claims adjudication and care management.
- Develop systems of care with providers for case management.
- Lead cost containment efforts and manage data analytics.
- Engage with regulatory agencies and provider partners.
Qualifications :
Seniority level
Executive
Employment type
Full-time
Job function
Management
Industries
Hospitals and Health Care
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