New York Licensed Utilization Review Medical Director

Job Summary

A company is looking for a Utilization Review Medical Director.

Key Responsibilities

• Conduct clinical reviews of Durable Medical Equipment (DME) authorization requests using applicable criteria
• Maintain continuous case throughput within a real-time review queue, adhering to productivity standards
• Document clinical decisions and provide guidance on clinical interpretation and complex case reviews

Required Qualifications

• MD or DO degree
• Ability to obtain a New York state medical license and any additional state licenses as needed
• Board certification in Internal Medicine, Family Medicine, or Physical Medicine & Rehabilitation
• Experience performing utilization management or clinical review activities
• Familiarity with electronic UM systems and DMEPOS reviews