Physician / Internal Medicine / New York / Permanent / Medical Director- Utilization Review and Case Management Job at Confidential

A Manhattan-based healthcare organization is actively seeking an experienced and compassionate professional to join their staff as their new Medical Director. In this role, the Medical Director will be responsible for assisting in ensuring appropriate health care utilization management (UM). Responsibilities The Medical Director will: Conduct analyses to identify trends and patterns Perform Peer-to-Peer discussions, as applicable, and educate physicians and others on current policy, medical management issues Assist the Chief Medical Officer in the identification and implementation of opportunities for improving the pre and post payment review process Assist in new technology assessment and clinical policy review as required and has facility in researching the evidence-based literature, including use of comparable database Perform other duties as needed and assigned by the Chief Medical Officer relevant to UM Appeals and clinical policy process Perform medical necessity reviews and appeal reviews Supervise retrospective review of claims to identify practice patterns that could be improved to reduce costs and improve case Conduct analyses to identify trends and patterns suggestive of, or indicative of inappropriate or excessive use of services or equipment Qualifications Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved school of medicine Valid and current NY license Board Eligible / Certification 2+ years' experience in a managed care setting, in particular utilization management 3+ years of clinical experience