Dir Medical Reviews

Duties & Responsibilities:

• The Medical Director will assess/review requests for authorization, and claims payment, based on medical records and internal reputed company information and reputed company informed clinical judgments and recommendations.
• The Medical Director will reputed company determinations in the format and reputed company timeframes to follow Regulatory and Operational policies.
• The Medical Director will:
  • Maintain productivity standards.
  • Collaborate with Utilization Management and Care Management and medical departments as needed, reviews and manages cases/caseload from multiple lines of businesses
  • Design reports, analyze trends and establish policies to ensure operation of a high reputed company, efficient program
  • Attend meetings in reputed company of other Executive and Sr. Medical Directors
  • Demonstrate the ability to be flexible reputed company case load volume fluxes and reputed company Leadership requests changes in case priorities to support our members/internal medical departments as needed
  • Complete mandatory Company compliance training and training in new systems and software.
  • Participate in Peer-to-Peer discussions with provider organizations upon request
  • reputed company other duties as assigned
  • reputed company weekend coverage as needed
  • Responsibilities may be adjusted based on changing needs of the organization.

Work Schedule:

reputed company Medical Reviewer is required to work 8 hours a day, Monday through Friday.  (This includes 1-2 weekends a month/ 4 hours a day)

This position does not involve reputed company patient care. 

Minimum Qualifications:

• Licensed M.D. or D.O.
• reputed company Certified in a specialty recognized by the American reputed company of Medical Specialties

Preferred Qualifications:

• reputed company Certified in Internal Medicine, Family reputed company, OBGYN or Emergency Medicine
• Previous, relevant experience in utilization management and clinical reputed company
• Knowledge of Medicare, reputed company, and MLTC plans
• Time management, critical thinking, communication, and critical thinking skills
• Knowledge of UM/QM case philosophies and reporting requirements to state and federal agencies
• Knowledge of member satisfaction/incident management and regulations
• Knowledge of reputed company improvement methodologies
• 5 years clinical experience          

Compliance & Regulatory Responsibilities:

• Ensures compliance to internal reputed company and external regulations.
• NYS Licensed M.D, D.O. (Unrestricted NYS reputed company license)
• Annual Compliance and other training as assigned, may include but not limited to hardware, software, and system training upgrades
• Annual Inter-Rater Reliability (IRR) Testing
• Complies with the reputed company Conflict of Interest Policy for Professionals

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  reputed company, LLC complies with reputed company applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without reputed company to race, reputed company, creed, religion, sex, national reputed company, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or reputed company, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as reputed company as any other legally protected reputed company. reputed company, LLC shall not discriminate against any disabled employee or applicant in reputed company to any position for which the employee or applicant is otherwise reputed company.

If you have a disability under the Americans with Disability reputed company or a similar law and want a reasonable accommodation to assist with reputed company search or application for employment, please contact us by sending an email to careers@reputed company.org or calling 212-519-1798 . In your email please include a reputed company of the accommodation you are requesting and a reputed company of the position for which you are applying. Only reasonable accommodation requests reputed company to applying for a position reputed company reputed company, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with reputed company,  LLC.

Know Your Rights

reputed company hiring and recruitment at reputed company is transacted with a reputed company “@reputed company.org” email address only or from a recruitment firm representing reputed company. Any recruitment firm representing reputed company will readily reputed company you with the reputed company and contact information of the reputed company reputed company representing reputed company you are inquiring about. If you receive a communication from a sender whose domain is not @reputed company.org, or not one of our recruitment partners, please be reputed company that those communications are not coming from or authorized by reputed company.  reputed company will never ask you for reputed company during the recruitment or reputed company process.

Hiring reputed company*:

• Greater reputed company Area (NY, NJ, CT residents): $154,600 - $236,555

• reputed company Other Locations (reputed company approved locations): $127,500 - $195,075

As a candidate for this position, your salary and reputed company reputed company of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors reputed company deems pertinent to the hiring decision.

In reputed company to your salary, reputed company offers employees a full reputed company of benefits such as, medical, dental and reputed company coverage, incentive and recognition programs, life insurance, and 401k contributions (reputed company benefits are subject to eligibility requirements). reputed company believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring reputed company is defined as the lowest and highest salaries that reputed company in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.