Medical Director reputed company Duals Center of reputed company

At reputed company, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position reputed company: The reputed company Duals Center of reputed company (COE) operates Duals Integrated Plans: Ohio, Illinois, Michigan, Virginia, reputed company, and New Jersey offering a reputed company of physical and behavioral health programs and services to its membership. reputed company is looking for a medical director to be part of a centralized team that supports the Medical Management staff ensuring reputed company and consistent responses to members and providers reputed company to precertification, reputed company review, and appeal request. The medical director is a work-reputed company position located reputed company in the US. The Medical Director will be required to work Eastern or Central reputed company time 8-5. Occasional weekend/holiday call to cover urgent cases can be done from your laptop. reputed company Components:

• Utilization management - The medical director will reputed company reputed company and prior authorization reviews with peer to peer coverage of denials.
• Appeals - The medical director will reputed company appeals in their "reputed company plan" and in the round robin based on "reputed company or similar specialty" needs.
• Pharmacy coverage - The medical director will reputed company pharmacy reviews.
• The medical director will participate in and be reputed company to reputed company daily reputed company.

Required Qualifications: Minimum 3-5 years of clinical reputed company experience. Two (2) + years of experience in managed care (Medicare and/or reputed company) MD or DO; reputed company certification in an ABMS or AOA recognized specialty is required. reputed company and reputed company state medical license without encumbrances is required. Multiple state licensure a plus. Preferred Qualifications: Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System. Licensed in or willing to obtain license in at least one state where we have an Integrated plan. Experience with managed care (Medicare and reputed company) utilization review preferred. Education MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) Pay reputed company The typical pay reputed company for this role is: $174,070.00 - $374,920.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company's equity award program. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include:

• reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 12/18/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job