Medical Director, Utilization & Policy

NYC Health + Hospitals; New York (NY); Sur place; USD 190 000 - 280 000; Plein temps

Résumé du poste

MetroPlusHealth, a wholly-owned subsidiary of NYC Health + Hospitals, seeks a Medical Director to oversee utilization management and advise on clinical policy. The role focuses on ensuring appropriate care and compliance across lines, including Medicare, with collaboration across clinical and policy teams.

Requirements include MD/DO, NY license, and multiple years in clinical practice and managed care. Strong leadership and communication skills are essential for policy discussions and program

Qualifications

• Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved school of medicine.
• A minimum of three years’ clinical experience.
• A minimum of two years’ experience in a managed care setting, in particular utilization management.

Responsabilités

• Performs Utilization Management for all lines of business, including Medicare.
• Conducts peer-to-peer discussions and educates physicians on current policies.
• Assists in technology assessment and clinical policy review.
• Performs medical necessity and appeal reviews.
• Supervises retrospective review of claims to identify practice patterns.
• Analyzes trends suggestive of inappropriate use of services or equipment.
• Participates in department committees as requested.

Connaissances

Integrity and Trust

Customer Focus

Functional/Technical Skills

Written/Oral Communications

Formation

MD or DO degree

Description du poste

MetroPlusHealth, a wholly-owned subsidiary of NYC Health + Hospitals, seeks a Medical Director to oversee utilization management and advise on clinical policy. The role focuses on ensuring appropriate care and compliance across lines, including Medicare, with collaboration across clinical and policy teams.

Requirements include MD/DO, NY license, and multiple years in clinical practice and managed care. Strong leadership and communication skills are essential for policy discussions and program