Medical Director, Utilization Management - Concurrent Review

The Medical Director, Utilization Management, will lead clinical review activities, including pre-service, concurrent, and retrospective utilization review, and provider claims dispute reviews. They will assist in clinical oversight of coordination of care, case management, health risk assessment, and individualized care plans. The role requires collaboration with the Sr. Medical Director, Utilization Management, to develop improved utilization of effective and appropriate services and support operational implementation of transformation initiatives.

Requirements

• Deliver and collaborate on clinical review activities
• Manage physician processes in support of utilization management and transactional functions for membership
• Perform pre-service, concurrent, and retrospective utilization review, and provider claims dispute reviews
• Assist in clinical oversight of coordination of care, case management, health risk assessment, and individualized care plans

Benefits

• Generous Paid Time Off
• 401k Matching
• Retirement Plan
• Health Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance