About this role

Lead, organize, and develop staff in administration of the Medical Review and Prior Authorization programs for government programs
Direct and oversee Medical Review and Prior Authorization programs ensuring performance expectations and compliance standards are met
Guide the Medical Review Team in developing and implementing effective Medical Review strategies
Serve as a liaison between internal and external stakeholders
Ensure compliance with CMS directives and analyze effectiveness

Bachelor's in a job related field
10 years healthcare program management, utilization/case management, or medical review management or equivalent military experience in grade E4 or above
Excellent verbal and written communication skills
Excellent organizational, customer service, analytical or critical thinking skills
Excellent presentation skills
Good judgment skills
Ability to persuade, negotiate, or influence others
Ability to evaluate existing processes and develop ways to streamline procedures
Strong organizational, analytical, communication, and decision-making skills
Knowledge of budget preparation and management
Microsoft Office proficiency
If RN, active RN licensure in state hired

Senior Medical Review Director

Key skills