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
• Participate in case rounds and develop UM/CM plans for individual members
• Analyze utilization patterns and ensure compliance with regulatory requirements

Required Qualifications, Training, and Education

• 3-5 years of health plan experience in medical management with Medicare and Medicaid Programs
• Experience with inpatient and outpatient utilization management
• Current and unrestricted Physician license to practice in NY
• Medical Doctorate is required; Master's Degree in public health is preferred
• Board Certification is preferred in relevant specialties