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Medical Director Physician

L7

tandym healthBrooklyn, NYyesterday

Occupations

Physicians, All OtherMedical and Health Services ManagersGeneral Internal Medicine Physicians

Industries

Offices of PhysiciansOffices of Physicians, Mental Health SpecialistsAll Other Miscellaneous Ambulatory Health Care Services
A New York City-based health services system is seeking a licensed professional to join their staff Remotely as their new Medical Director - Utilization Management.
About the Opportunity
Shift: DaySchedule: Monday to Friday
Hours: Standard business
Setting: Remote
Responsibilities: Perform utilization management across all lines of business, including Medicare. Conduct peer-to-peer discussions and educate physicians on policies and medical management issues. Support new technology assessment and clinical policy review through evidence-based research. Review medical necessity and appeal cases. Analyze utilization patterns, retrospective claims, and potential fraud, waste, and abuse indicators.
Qualifications:
  • Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved School of Medicine
  • Minimum of 3 years of Clinical experience
  • Minimum of 2 years of experience in a Managed Care setting, particularly Utilization Management
  • Valid New York State medical license and current registration to practice medicine in New YorkBoard certification or board eligibility
Desired Skills:
  • Experience conducting case manager rounds.
  • Experience participating in medical policy, credentials, or similar committees
  • Exposure to out-of-network provider utilization management
Apply now (opens in a new tab)
Apply now (opens in a new tab)

Level

ManagerL7

Location

Brooklyn, NY

Occupation

Physicians, All Other

Industry

Offices of Physicians

Posted

yesterday

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