Medical Director of Utilization Management (MD/DO) (255057)
$275k - $315kMedix
Title: Medical Director of Utilization Management
Candidates should take the time to read all the elements of this job advert carefully Please make your application promptly.
Summary: Step into a strategic leadership position as the Clinical Lead for a prominent Health Plan's Utilization Management (UM) Department. You will oversee clinical strategy, quality improvement, and cost-effectiveness across government-sponsored health programs in New York.
Day to Day:
- Provide clinical oversight for UM services, complex case reviews, appeals, and peer-to-peer discussions.
- Document case reviews and rationales in enterprise care management software.
- Join Interdisciplinary Care Team (ICT) rounds to support care continuity for members.
- Analyze regional utilization trends and implement strategies to meet benchmarks.
- Ensure regulatory compliance and lead departmental preparation for State/Federal audits.
- Propose annual goals and deliver progress reports to executive leadership.
Shift:
- Monday – Friday, 9:00 AM – 5:00 PM
- Hybrid schedule (2 days/week in-office in NYC; must reside in NY, NJ, or CT).
Qualifications:
- Education & Licensure: MD or DO with an active, unrestricted NY medical license.
- Experience: 4 - 5 years in health plan medical management with Medicare/Medicaid (MLTC, MAP, D-SNP, MAPD).
- Scope: Experience with inpatient/outpatient UM, medical necessity, pharmacy, and appeals.
- Certifications: Board Certification preferred (Internal, Family, or Emergency Medicine). MPH/MHA a plus.
- Requirement: Must have no active group practice or hospital affiliations in New York. xhyhwjd
Perks!:
- Competitive Salary: $275,000 - 315,000 / year
- High-impact leadership role with a hybrid schedule (3 days remote / 2 days onsite)
Vacancy posted 3 days ago
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