Job Description
Description Job Summary: The Medical Director for Utilization Management provides strategic and operational oversight for the denial functions of the System Enterprise Services (SES) Physician Advisor program. This role supports appropriate reimbursement for high-quality, cost-effective, and safe patient care by aligning with regulatory, professional, and organizational standards, in coordination
7:00 AM
Review the surgical and procedure schedule for the next 48–72 hours. Every case that requires authorization needs to be cleared be…
7:30 AM
Pull the PA worklist. Filter by date of service — cases with the earliest service dates get worked first. High-cost procedures (su…
8:30 AM
Submit PA requests to payers. Each payer has its own portal, its own forms, its own documentation requirements. You know them all…
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