Medical Director – Medical Operations

Job not on LinkedIn

🔥 13 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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👻 Ghost score 10%

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Geisinger

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1915

🏥 Healthcare

💊 Pharmaceuticals

🧘 Wellness

Healthcare • Pharmaceuticals • Wellness

Geisinger is a healthcare organization that has been providing accessible medical services for over a century in Pennsylvania. It focuses on meeting the healthcare needs of its communities and is dedicated to innovative patient care. With career opportunities in various fields including nursing, allied health, and administration, Geisinger promotes professional development and a supportive workplace for its employees, emphasizing diversity, equity, and inclusion.

📋 Description

• 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

🎯 Requirements

• Doctor of Medicine or Doctor of Osteopathic Medicine (Required) • Licensed Medical Doctor - State of Pennsylvania • Office Administration skills • Ability to work in a clinical and office environment • Ability to travel as required • Ability to satisfy job-specific obligations and comply with organization policies and procedures

🏖️ Benefits

• Healthcare benefits for full-time and part-time positions from day one • Vision insurance • Dental insurance • Domestic partner benefits • Collaborative, cooperative, and collegial work atmosphere