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Medical director

Company: MESSA
Location: East Lansing
Posted on: November 19, 2021

Job Description:

The medical director will consult with and advise MESSA on providing quality healthcare and disability coverage to MESSA members. The medical director will work with MESSA and its underwriters on matters of medical necessity, quality and reasonableness of medical treatment in concurrent reviews and in appeals decisions. This position is that of an independent contractor; it involves approximately 20 hours per week. It is based in East Lansing, Mich., and may be partly remote. MESSA (www.messa.org) is an East Lansing-based nonprofit voluntary employees' beneficiary association (VEBA). We provide our members and their families with the largest provider network in Michigan, comprehensive medical and prescription coverage and outstanding personal service. We also offer vision, dental and short-term and long-term disability benefits. We believe the hardworking people who care for our kids, our schools and our communities deserve exceptional health benefits and unmatched personal service. MESSA is deeply committed to diversity and inclusion. We are an affirmative action, equal opportunity employer. People of color, women, and members of other historically marginalized social identity groups are encouraged to submit a letter of interest. The medical director:

  • Performs physician-level review of medical and disability claims and preauthorization requests for coverage determinations.
  • Determines medical necessity of requests, including appeals, using medical policy, established guidelines or current research
  • Serves as a clinical resource and subject matter expert to both clinical and non-clinical staff
  • Recommends clarifications and updates to medical benefits, including assisting in identifying experimental/investigational treatment(s) and newer technologies, surgeries and medications
  • Participates in quality initiatives, case management accreditation and utilization management to identify opportunities for improvement
  • Participates in pharmacy initiatives and reviews of requested prescription drugs
  • Reviews requests for over-age dependents, including appeals
  • May be asked to participate in committees and workgroups to achieve department and organizational objectives
  • Various other duties as the need arises YourMembership. Keywords: Medical Director, Location: East Lansing, MI - 48826

Keywords: MESSA, East Lansing , Medical director, Executive , East Lansing, Michigan

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