Director of Medical Reviews

Job Description

We are seeking a Director of Medical Reviews to conduct medical necessity reviews for utilization management and appeals. The ideal candidate will assess requests for authorization and claims payment, collaborate with Utilization Management, Care Management, and medical departments as needed, maintain productivity standards, and complete mandatory company compliance training.

Qualifications

1. Licensed M.D. or D.O. 2. Board Certified in a specialty recognized by the American Board of Medical Specialties 3. Board Certified in Internal Medicine, Family Practice, OBGYN, or Emergency Medicine 4. Relevant experience in utilization management and clinical practice 5. Knowledge of Medicare, Medicaid, and MLTC plans 6. 5 years clinical experience

Benefits

- Medical, dental, and vision coverage - Incentive and recognition programs - Life insurance - 401k contributions