Working with departmental medical review nurses, the Medical Director – Utilization Review for Medical Management reviews requests, to approve or deny, for medical services and confinements using clinical judgment, evidence based standards and organizational policies; decisions are then communicated to the medical review staff. The MD evaluates and renders decisions on appeals of medical necessity denials. This position is responsible for daily utilization decisions but may assist in the development of medical policy, development of data to support policy change and special medical management projects under the direction of Senior Staff.
• 5+ years of related experience
• Doctor of Medicine required
• Must be a board certified physician licensed to practice in New York
• Managed Care experience required
• Utilization Review Experience required