Executive: Medical Director ( PRN/ Temporary) - Federal Way, Washington - (Federal Way, WA)

Medical Director ( PRN/ Temporary) Description: Summary The Physician Consultant's foremost role is to provide medical director services as an adjunct and support of the daily activities of the Medical Director (MD) and the CMO. This includes providing coverage determinations, appeal reviews, performing peer-to-peer outreach, and supporting select quality initiates on an as-needed basis. The Physician Consultant, collaborating with the Medical Director (MD) and CMO, will support the QualChoice Health Plan Services Medicare Advantage Care Management and Pharmacy teams, being responsible for ensuring the effective utilization of medical services through the application of nationally recognized medical necessity criteria. The Physician Consultant is responsible for ensuring CMS compliance as relates to turn-around-times and documentation qualifications. Additionally, the Physician Consultant will assist with needed PAID-TIME-OFF back-up.