New York Licensed Medical Director

Job Summary

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

Key Responsibilities

• Provide oversight to the delivery of utilization management services, including case reviews and appeals
• Utilize the care management system to document case reviews and participate in case rounds for continuity of care
• Analyze utilization patterns and ensure compliance with regulatory and contractual requirements

Required Qualifications, Training, and Education

• 3-5 years of health plan experience in medical management with Medicare and Medicaid Programs
• Experience with both inpatient and outpatient utilization management
• Medical Doctorate is required
• Current and unrestricted Physician license to practice in NY is required
• Preferred: Board Certified in internal medicine, emergency medicine, or family medicine