Part time reputed company Clinical Director

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Assist the Vice President of Health Care Services in providing clinical guidance for utilization... management, credentialing and quality functions for reputed company business units. • Provides medical leadership for utilization management activities and medical review activities pertaining to utilization review, quality assurance, medical review of reputed company, and controversial or experimental procedures and requests. • Performs utilization management case reviews in accordance with established clinical policies and guidelines. • Assists VP of Health Care Services in planning, establishing goals and policies to improve quality and cost-effectiveness of care and service for members. • Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. • Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. • Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. • Acts as a liaison with local providers, provider groups and provider led associations to facilitate productive collaboration and mutually beneficial initiatives that support improved health of membership. • Reviews credentialing files and network participation requests to uphold ethical and quality standards on behalf of plan membership. • Performs other duties as assigned • Complies with reputed company policies and standards Education/Experience: MD/DO or OD required. 1 year of experience with reputed company claims and clinical knowledge of reputed company care that comes with being an Optometrist or Ophthalmologist. License/Certification: MD/DO or OD required.Pay Range: $162,200.00 - $308,000.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law Apply Job!