New York Licensed Medical Director

Job Summary

To support healthcare quality and outcomes, the remote contract Medical Director will oversee the administration of medical services, conduct peer-to-peer reviews, and provide strategic guidance for utilization management operations.

Key responsibilities

• Conduct peer-to-peer clinical reviews to discuss medical necessity determinations and treatment plans
• Review clinical appeal cases and provide determinations to attending or ordering providers as needed
• Interpret medical policies and clinical guidelines to support consistent utilization decisions

Required qualifications

• MD or DO required, with board certification through an ABMS- or AOA-approved board
• Board certification in Internal Medicine or Geriatrics strongly preferred
• Active, unrestricted New York medical license required
• Minimum of 10 years of clinical experience required
• Prior utilization management experience strongly preferred