Medical Director
Core
Provide medical leadership for utilization management, cost containment, and quality improvement activities for a business unit.
Role type
Senior IC Medical Director (Utilization Management)
Builds
Utilization management programs, quality improvement initiatives, and provider network strategies
Domain
Healthcare administration and insurance
Required skills
Board certification in a medical specialty, active NY MD/DO license, utilization management experience, knowledge of quality accreditation standards, clinical review expertise, provider network development, performance improvement strategy, claims adjudication for complex cases, stakeholder collaboration
Preferred skills
Health administration coursework, health financing knowledge, experience with culturally diverse populations, active clinical practice
Technologies
None stated
Responsibilities
Direct and coordinate medical management and credentialing functions, perform medical reviews for utilization and quality assurance, implement performance improvement initiatives for capitated providers, conduct rounds for high-risk patients, collaborate on complex case reviews and appeals, participate in provider network development, develop physician education programs, evaluate utilization trends and adverse patterns, represent the business unit at state committees and public forums
Seniority
Senior, hands-on IC