New York Licensed Medical Director

Job Summary

To support a growing health plan, the part-time Medical Director of Utilization Management will oversee utilization management services, participate in case reviews, and ensure compliance with regulatory requirements while working remotely from New York, New Jersey, or Connecticut.

Key responsibilities

• Provide oversight for utilization management services, including case reviews and appeals
• Analyze utilization patterns and implement strategies to align them with benchmarks
• Participate in regulatory audits and maintain knowledge of compliance requirements

Required qualifications

• Medical Doctorate required; Master's Degree in public health preferred
• Current and unrestricted Physician license to practice in New York
• 3-5 years of health plan experience in medical management with Medicare and Medicaid programs
• Experience with both inpatient and outpatient utilization management
• Board Certification preferred in internal medicine, emergency medicine, or family medicine