Job Title: Medical Director – Utilization Management

Location: Remote – Preference EST or nearby Pittsburgh PA,NY,WV

Duration: 6+ Months Contract with possible extension

 

Position Overview

As part of a physician team, the Medical Director ensures utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of requested treatments or services. Depending on the nature of the case, telephonic peer-to-peer discussions may be required. The Medical Director ensures compliance with NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of a multidisciplinary team for case and disease ...