Medical Director
Athari
New York, new york
The Medical Director can be a fully remote position
The Medical Director is responsible for assisting in ensuring appropriate health care utilization management (UM). The Medical Director serves as a physician and policy advisor to the Plan’s Chief Medical Officer.
Job Description
Performs Utilization Management related to inpatient level of care and home care services. Additional UM may cover other areas such as appropriate use of out of network providers. Conducts peer to peer discussions, as applicable, and educates physicians (in-network and out-of-network) and others on current policies and medical management issues. Assists in new technology assessment and clinical policy review, as required, and facilitates researching the evidence–based literature.
- Performs medical necessity and appeal reviews
- Supervises retrospective review of claims to identify practice patterns that could be improved to...