New York Licensed Medical Director

Job Summary

A company is looking for a Medical Director of Utilization Management.

Key Responsibilities

• Oversee the delivery of utilization management services, including case reviews and appeals
• Develop and implement strategies for inpatient reviews and care transitions
• Analyze utilization patterns and collaborate with finance on claims analysis

Required Qualifications, Training, and Education

• 3-5 years of health plan experience in medical management with Medicare and Medicaid Programs
• Experience in both inpatient and outpatient utilization management
• Current and unrestricted Physician license to practice in NY
• Medical Doctorate required; Master's Degree in public health preferred
• Board Certified in internal medicine or geriatrics preferred