Medical Director – Utilization Management

Role Overview

• Processes second level reviews in compliance with Medicare/CMS
• Provides appropriate level of care classifications and continued stay reviews in compliance with CMS
• Acts as a liaison between the medical staff, utilization review, and 3rd party payers
• Reviews the entire claim denial process, including Appeals and Grievances
• Serves as a Physician member of the utilization review team

Requirements

• Minimum of 3 years of experience in hospital-wide or skilled nursing facility position involving clinical care, quality management, utilization and case management, or medical staff governance required.
• Completion of medical school and specialty residency (preferably in internal medicine) required.
• Must have current, non-restricted licensure as required for clinical practice in the state of California.

Benefits

• Health insurance
• 401(k)
• Paid time off