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Full Time Medical Director Job New York, NY

Full Time
New York, NY
275382
alarm yesterday
Posted by ExecuSearch Group
Employer The Execu|Search Group

Job Description

A Manhattan-based healthcare organization is actively seeking an experienced and compassionate professional to join their staff as their new Medical Director. In this role, the Medical Director will be responsible for assisting in ensuring appropriate health care utilization management (UM).

Responsibilities

The Medical Director will:

  • Conduct analyses to identify trends and patterns 
  • Perform Peer-to-Peer discussions, as applicable, and educate physicians and others on current policy, medical management issues
  • Assist the Chief Medical Officer in the identification and implementation of opportunities for improving the pre and post payment review process
  • Assist in new technology assessment and clinical policy review as required and has facility in researching the evidence–based literature, including use of comparable database
  • Perform other duties as needed and assigned by the Chief Medical Officer relevant to UM
  • Appeals and clinical policy process
  • Perform medical necessity reviews and appeal reviews
  • Serve as co-chair for Credentialing Committee
  • Serve as co-chair of the Utilization Management Subcommittee
  • Supervise retrospective review of claims to identify practice patterns that could be improved to reduce costs and improve case 
  • Conduct analyses to identify trends and patterns suggestive of, or indicative of inappropriate or excessive use of services or equipment

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
  • 2+ years’ experience in a managed care setting, in particular utilization management
  • 3+ years of clinical experience
Your privacy is important to us. For consideration, please submit your CV in confidence and our recruiter will contact you to discuss job location and details before forwarding your CV to our client for an interview.