Network Health WI

The role involves assisting members and providers with healthcare inquiries regarding benefits, claims, and authorizations via phone and email. The representative is responsible for documenting interactions and collaborating with internal departments to ensure first-call resolution.

The Associate Medical Director manages procedures and standards to ensure the quality and efficiency of healthcare delivered to members. This includes chairing quality committees and overseeing utilization management and clinical decision-making processes.

The Associate Medical Director supports the CMO by overseeing the administration of procedures, protocols, and standards to ensure the efficiency and quality of healthcare delivered to Network Health members, including chairing quality and accreditation committees. Key duties involve assisting with monitoring care appropriateness, participating in utilization management decisions, contributing to quality guideline development, and providing medical consultation on various complex issues.