Medical Director - Utilization Management (Remote)
Core
Perform clinical utilization management, peer review activities, and clinical quality management for healthcare organizations.
Role type
Senior Medical Director / Physician Advisor (Utilization Management)
Builds
Clinical review decisions and quality assurance reports for payer/healthcare clients
Domain
Healthcare / Utilization Management
Required skills
Clinical care experience, Utilization management, Peer review, Quality management, Regulatory compliance, State medical licensure, Board certification (via careerplan.io/jobs/39-004-18-365-medical-director-utilization-management-remote)
Preferred skills
Prior utilization management program administration, URAC accreditation knowledge
Technologies
Computer, telephone, office equipment
Responsibilities
Perform utilization management case reviews, Maintain productivity and quality scores, Complete inter-rater reliability testing, Respond to licensing/CME requests, Participate in company evaluation processes
Seniority
Senior, hands-on IC