RN Licensed Senior Medical Director

Job Summary

A company is looking for a Senior Medical Review Director to lead and develop staff in the administration of Medical Review and Prior Authorization programs.

Key Responsibilities

• Ensure compliance with CMS directives and analyze the effectiveness of Medical Review and Prior Authorization operations
• Develop and implement strategies for the Medical Review and Prior Authorization Program, including error rate reduction plans
• Serve as a liaison between internal and external stakeholders, resolving priority level problems from providers and CMS

Required Qualifications, Training, and Education

• Bachelor's degree in a job-related field
• 10 years of experience in healthcare program management, utilization/case management, or medical review management
• Knowledge of budget preparation and management
• If RN, active RN licensure in the state hired
• Proficiency in Microsoft Office and knowledge of medical systems software