Medical Director Physician

A New York City-based health services network is actively seeking an experienced, licensed professional to join its staff in Manhattan as its new VP of Medical Directors.

About the Opportunity:

• Schedule: Monday to Friday
• Setting: Hybrid (at least 3 days a week onsite; Thursdays are mandatory)
• Notes: 100% administratie role; no clinical responsibilities

Responsibilities:

• Reviews cases, determines medical necessity, and consults with physicians to review length of stay and reimbursement documentation
• Supports the Utilization Management (UM) department staff and nurse Care Managers on concurrent review and preauthorization referrals and ensures that members receive appropriate services consistent with their benefits, regulatory requirements, and established clinical criteria
• Works with the VP of Clinical Services, who oversees day-to-day UM operations. Provides clinical support for member and provider appeals.
• Builds a health informatics function and ensures decisions are made according to data insights.
• Assists in new technology assessment and clinical policy review as required.
• Participates in the development of strategic planning for existing and expanding businesses

Qualifications

• Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved school of medicine
• Valid and current license to practice medicine in the state of New York
• Board Eligible / Certification
• 3+ years' experience in a managed care setting, in particular, utilization management

Your privacy is important to us. For consideration, please submit your CV in confidence, and our recruiter will contact you to discuss the job location and details before forwarding your CV to our client for an interview.