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

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

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