Medical Director – Medical Operations

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Oversee the medical management of Health Plan inpatient activities, encompassing acute inpatient, LTAC, observation, SNF, rehabilitation, and ambulatory surgery.

• Create and execute the Health Plan Medical Management Plan tailored for inpatient services.

• Work in partnership with Health Plan Medical Directors to address medical objectives across various regions.

• Collaborate with Medical Directors in Medical Home and Informatics to establish and monitor the Medical Management Plan.

• Assist with retrospective claims audits and verification of claims.

• Support the Evidence of Insurability and Over Age Dependent processes.

• Provide assistance to Geisinger Home Health nurses regarding DME, Home Health, and rehabilitation matters.

• Offer advice on medical appropriateness, benefit application, level of care, and out-of-network services.

• Ensure thorough and prompt documentation.

• Engage in Medical Director On-Call, On-Duty, and Appeals Committee responsibilities.

• Manage the appeals process for practitioners and providers.

• Guarantee the quality, precision, and timely completion of correspondence related to denials and appeals.

• Participate in the Plan Pharmacy and Therapeutics Committee.

⛳️ Requirements

• Doctor of Medicine or Doctor of Osteopathic Medicine (Mandatory).

• Licensed Medical Doctor in the State of Pennsylvania.

• Proficient in Office Administration skills.

• Capability to operate in both clinical and office settings.

• Willingness to travel as needed.

• Ability to meet job-specific responsibilities and adhere to organizational policies and procedures.

🏝️ Benefits

• Healthcare benefits available for both full-time and part-time roles from day one.

• Vision insurance.

• Dental insurance.

• Benefits for domestic partners.

• A collaborative, cooperative, and collegial work environment.