Wisconsin Licensed Senior Medical Director

Job Summary

A company is looking for a Senior Medical Director specializing in Medical Management.

Key Responsibilities

• Conduct medical necessity reviews and determinations of prior authorizations and referrals
• Oversee a team of Associate Medical Directors and the Medical Policy Development team
• Provide clinical strategy and physician input to various Clinical Services departments

Required Qualifications

• MD or DO with current and ongoing Board Certification in an ABMS Medical Specialty
• Unrestricted current medical license in the state of Wisconsin and other states as necessary
• 12+ years of direct clinical patient care experience post residency or fellowship, with at least 3 years in managed care
• Knowledge of medical management principles and experience with national guidelines such as MCG and InterQual
• Familiarity with NCQA HEDIS principles and CMS Star ratings for Medicare lines of business