Medical Director - Utilization & Policy Strategy (Remote)

MetroPlus; New York (NY); On-site; USD 200,000 - 300,000; Full time

Job summary

MetroPlus in New York seeks a Medical Director focused on health care utilization management. The position involves overseeing medical necessity reviews, conducting peer discussions, and guiding policy implementation. Candidates should possess a Doctor of Medicine or Doctor of Osteopathic Medicine degree and have significant experience in managed care settings.

The ideal applicant will have a valid New York State license and demonstrate strong competencies in integrity, communication, and customer focus.

Qualifications

• Minimum three years clinical experience in medicine.
• Two years experience in a managed care setting, particularly in utilization management.

Responsibilities

• Perform utilization management for all lines of business including Medicare.
• Conduct peer to peer discussions and educate physicians on policies.
• Assess new technology and review clinical policies.

Skills

Integration of health care utilization management

Peer-to-peer discussions

Analysis of clinical policies

Education

Doctor of Medicine or Doctor of Osteopathic Medicine

Job description

MetroPlus in New York seeks a Medical Director focused on health care utilization management. The position involves overseeing medical necessity reviews, conducting peer discussions, and guiding policy implementation. Candidates should possess a Doctor of Medicine or Doctor of Osteopathic Medicine degree and have significant experience in managed care settings.

The ideal applicant will have a valid New York State license and demonstrate strong competencies in integrity, communication, and customer focus.