Director of Medical Reviews
Healthfirst
full-time
Posted on:
Location Type: Remote
Location: Connecticut • New Jersey • United States
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Salary
💰 $154,600 - $236,555 per year
Job Level
About the role
- Conducting medical necessity reviews in the context of utilization management and appeals
- Assess/review requests for authorization, and claims payment
- Collaborate with Utilization Management and Care Management and medical departments as needed
- Maintain productivity standards
- Complete mandatory Company compliance training
Requirements
- Licensed M.D. or D.O.
- Board Certified in a specialty recognized by the American Board of Medical Specialties
- Board Certified in Internal Medicine, Family Practice, OBGYN or Emergency Medicine
- Previous, relevant experience in utilization management and clinical practice
- Knowledge of Medicare, Medicaid, and MLTC plans
- 5 years clinical experience
Benefits
- medical, dental and vision coverage
- incentive and recognition programs
- life insurance
- 401k contributions
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical necessity reviewsutilization managementclaims paymentauthorization requestsclinical practice
Soft Skills
collaborationproductivity standards
Certifications
Licensed M.D.Licensed D.O.Board CertifiedAmerican Board of Medical Specialties