New York Licensed Medical Director

Job Summary

A company is looking for a Director of Medical Reviews.

Key Responsibilities

• Conduct medical necessity reviews and make clinical judgments based on medical records
• Collaborate with various departments to manage cases and ensure compliance with regulatory policies
• Design reports and analyze trends to improve quality and efficiency in medical reviews

Required Qualifications

• Licensed M.D. or D.O
• Board Certified in a specialty recognized by the American Board of Medical Specialties
• 5 years of clinical experience
• Knowledge of Medicare, Medicaid, and MLTC plans
• Experience in utilization management and clinical practice