Medical Director, Utilization Management

The Medical Director, Utilization Management provides clinical oversight of authorization decision making and processing, pre and post payment claims review activities, payment integrity clinical validation and program integrity functions. This position requires evaluation and insight for both medical and behavioral health cases. In this position, the Medical Director supports the development of and ensures the application of clinical policies are consistent with evidence-based medicine and regulatory requirements.

Requirements

• At least 8 years of experience in medical management, managed care and quality management.
• Experience in Payment Integrity.
• Experience in maintaining liaison with Federal, State, and local bodies and medical organizations.
• Experience in performance management and possession of strong analytic ability.
• Extensive post-medical degree experience in clinical practice.
• Significant experience in a clinical development, medical affairs, or management role within the biotech, pharmaceutical, or healthcare industry.
• Proven experience in a physician leadership role, including managing teams.

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)