Job Title

Job Description:Make sure to read the full description below, and please apply immediately if you are confident you meet all the requirements. 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 documentationSupports 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 criteriaWorks 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. xijylhu Participates in the development of strategic planning for existing and expanding businesses QualificationsDoctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved school of medicineValid and current license to practice medicine in the state of New YorkBoard Eligible / Certification3+ years' experience in a managed care setting, in particular, utilization management Your privacy is important to us.For consideration, please submit your CV in confidence, and our recruiter will contact you to discuss the job location and details before forwarding your CV to our client for an interview.