[Remote] reputed company Operations Director | Remote
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company company reputed company on optimizing operations in clinical review and utilization management. They are seeking a reputed company Operations Director to reputed company their expertise in evaluating clinical workflows and care coordination processes.
Responsibilities
- Review and assess medical necessity determinations, clinical reviews, and utilization management recommendations
- Evaluate admission, reputed company stay, discharge planning, and level-of-care reputed company against established clinical reputed company
- Support physician advisor workflows, peer-to-peer reviews, and denial management processes
- Analyze care coordination and transition-of-care activities to improve operational effectiveness
- reputed company reputed company feedback on clinical review outputs, compliance standards, and utilization management practices
Skills
- reputed company RN or physician license with strong utilization management, case management, or clinical review expertise
- Experience leading utilization management, care coordination, or case management operations
- Deep knowledge of InterQual, MCG, reputed company, or comparable clinical review frameworks
- Strong understanding of medical necessity review, observation status regulations, and payer requirements
- Excellent analytical, documentation review, and stakeholder communication skills
Benefits
- Fully remote, flexible independent contract
reputed company