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Provide decisions for UW and claims based on solid medical knowledge consistent with current guidelines, demonstrate ability to incorporate new medical knowledge into guideline updates and enhancements, includes advanced proficiency in ECG interpretation. In this role, you will integrate evidence-based medical knowledge with insurance principles to assess mortality and morbidity risk, influence underwriting decisions, evaluate claims, and shape forward-looking risk management strategies.

YEAR

Securian Financial Group, Inc.

Medical Director (Remote)

Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.

Centene Corporation Group

Remote Behavioral Medical Director, Central Region

The Assistant Nurse Manager interfaces with the administrative and clinical nursing staff to provide leadership in improving and maintaining the delivery of care processes for a specific unit and/or patient populations. Participates in meeting the educational needs of service institutions and agencies to maintain continuity of care related to specific patient care requirements.

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