Medical Director, Utilization & Care Management
Highmark Health
Highmark Inc. seeks a physician to join a dedicated team and lead utilization management activities in line with NCQA, URAC, CMS, and DOH standards. The role reviews escalated cases electronically and via policy criteria to determine medical necessity and appropriateness of services. The physician will participate in multidisciplinary CMDM discussions, contribute to protocol development, and may work on special projects to improve member care. Telephonic peer-to-peer discussions may be required. #J-18808-Ljbffr Highmark Health
Vacancy posted 2 days ago
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