Utilization Management Medical Director

Role Overview

• rely on medical background and review health claims
• provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards
• make decisions on moderately complex to complex issues regarding technical approach for project components
• exercise considerable latitude in determining objectives and approaches to assignments

Requirements

• MD or DO degree
• Three years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age)
• Current and ongoing board certification an approved ABMS medical Specialty, or other board demonstrating advanced training in transitions of care, quality assurance, utilization management and care coordination
• A current and unrestricted medical license in at least one jurisdiction and willing to obtain additional license
• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
• Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on transitions of care, quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation.

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance
• many other opportunities