The Medical Director provides leadership, organization, and direction for claims review programs and may assist in the Utilization management programs and services. Responsible for the overall quality, effectiveness and coordination of Company medical services. Directs aspects of the medical claims reviews and coordinates these with Quality Improvement programs for the company. The Medical Director will participate in all aspects of claim review services including provider telephonic discussions and provider appeals. The Medical Director may also be asked to assist in direction and oversight in the development and implementation of Policies and procedures and clinical criteria for all medical programs and services. S/he will serve as a liaison between Company, physicians, and other medical service providers in selected situations primarily related to medical claim reviews.