Medical Director Physician
tandym healthBrooklyn, NY
Medical Director Physician
tandym healthBrooklyn, NY
25 days ago
Occupations
Physicians, All OtherMedical and Health Services ManagersGeneral Internal Medicine PhysiciansIndustries
Offices of PhysiciansOffices of Physicians, Mental Health SpecialistsAll Other Miscellaneous Ambulatory Health Care ServicesAbout the role
A New York City-based health services system is seeking a licensed professional to join their staff Remotely as their new Medical Director - Utilization Management.
About the Opportunity
Shift: DaySchedule: Monday to Friday
Hours: Standard business
Setting: Remote
Responsibilities:
Perform utilization management across all lines of business, including Medicare.
Conduct peer-to-peer discussions and educate physicians on policies and medical management issues.
Support new technology assessment and clinical policy review through evidence-based research.
Review medical necessity and appeal cases.
Analyze utilization patterns, retrospective claims, and potential fraud, waste, and abuse indicators.
Qualifications:
- Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved School of Medicine
- Minimum of 3 years of Clinical experience
- Minimum of 2 years of experience in a Managed Care setting, particularly Utilization Management
- Valid New York State medical license and current registration to practice medicine in New YorkBoard certification or board eligibility
Desired Skills:
- Experience conducting case manager rounds.
- Experience participating in medical policy, credentials, or similar committees
- Exposure to out-of-network provider utilization management
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JOB OVERVIEW
Experience level
Manager
Location
Brooklyn, NY
Occupation
Physicians, All Other
Industry
Offices of Physicians
Posted
25 days ago
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