Director of Medical Reviews
HealthfirstNew York, New York, United States • New Jersey, United States • Connecticut, United States
Posted April 15, 2026
127500 - 236555 USD
Full Time
About the Company
Healthfirst believes that every New Yorker deserves access to the best available healthcare. As one of New York’s highest quality not-for-profit health insurers serving close to two million New Yorkers, we make this a reality for our members. Founded more than 30 years ago by the leading hospital systems in downstate New York, Healthfirst established a partnership model that enables hospitals, health systems, and physicians in our network to prioritize health outcomes over profits, placing the needs of our members and community first. Healthfirst serves members in New York City, on Long Island, and in Westchester, Rockland, Sullivan, and Orange counties, offering market-leading products to suit every life stage. Our offerings include Medicaid plans, Medicare Advantage plans, Child Health Plus plans, Essential Plans, Long-Term Care plans, and Qualified Health plans. For more information on Healthfirst, please visit healthfirst.org.
Job Description
The Director, Medical Reviews position is responsible for conducting medical necessity reviews in the context of utilization management and appeals and managing the development and implementation of quality improvement initiatives. The Medical Director will assess/review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations.
Requirements
- Licensed M.D. or D.O.
- Board Certified in a specialty recognized by the American Board of Medical Specialties
- 5 years clinical experience
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Incentive and recognition programs
- Life insurance
- 401k contributions
