Job Details

A company is looking for a Medical Director of Utilization Management.Key ResponsibilitiesOversee the delivery of utilization management services, including case reviews and appealsParticipate in case rounds and develop UM/CM plans for individual membersAnalyze utilization patterns and ensure compliance with regulatory requirementsRequired Qualifications, Training, and Education3-5 years of health plan experience in medical management with Medicare and Medicaid ProgramsExperience with inpatient and outpatient utilization managementCurrent and unrestricted Physician license to practice in NYMedical Doctorate is required; Master's Degree in public health is preferredBoard Certification is preferred in relevant specialties