Medical Director - Utilization & Quality Optimization
Comunidade Metodista
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Job summary
HealthCare Partners, MSO seeks a Medical Director - UM Reviewer to assure appropriate and optimized care for members. The role centers on medical necessity reviews, prior authorizations, concurrent and retrospective reviews, and appeals determinations, serving as a clinical expert for teams in utilization management and program development.
Requirements include MD/DO, board certification, and an active NY license, with a minimum of five years of clinical practice and two in managed care.
Job description
HealthCare Partners, MSO seeks a Medical Director - UM Reviewer to assure appropriate and optimized care for members. The role centers on medical necessity reviews, prior authorizations, concurrent and retrospective reviews, and appeals determinations, serving as a clinical expert for teams in utilization management and program development.
Requirements include MD/DO, board certification, and an active NY license, with a minimum of five years of clinical practice and two in managed care.
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