Medical Director, Utilization Management at Bickham Services Unlimited LLC | chakrie

Requirements

Active, unrestricted M.D. or D.O. license in good standing.
Current board certification in an appropriate medical specialty.
At least 5 years of clinical experience, including at least 3 years of experience in utilization management, physician review, or medical leadership within a managed care or health plan environment.
Physician-level utilization management experience supporting Commercial and/or Medicare Advantage populations.
Strong experience with inpatient and post-acute care reviews and medical necessity determinations.
Knowledge of commercial benefits, coverage requirements, and medical policies.
Knowledge of Medicare Advantage and CMS coverage criteria.
Experience applying MCG and/or InterQual guidelines.
Experience conducting peer-to-peer discussions and communicating complex or adverse determinations.
Candidate must reside in or hold applicable licensure for New Jersey.
Master's degree such as MPH, MBA, or MHA.
ABQAURP certification.
Experience with quality improvement, regulatory compliance, accreditation, or delegated oversight.

Salary: DOE

Originally posted on Himalayas

Responsibilities

A clear overview of what is expected, written by the people who posted it, with every detail you need to decide.

Qualifications, experience and the skills that matter most, along with anything that would make you stand out.

Practical next steps, the documents to prepare and the dates to keep in mind before you apply or get in touch.

Contact details, links to the official source and the notes our team adds after checking each listing by hand.

Skills & expertise

Qualifications, experience and the skills that matter most, along with anything that would make you stand out.

Practical next steps, the documents to prepare and the dates to keep in mind before you apply or get in touch.

Contact details, links to the official source and the notes our team adds after checking each listing by hand.

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Salary & benefits

A clear overview of what is expected, written by the people who posted it, with every detail you need to decide.

Qualifications, experience and the skills that matter most, along with anything that would make you stand out.

Practical next steps, the documents to prepare and the dates to keep in mind before you apply or get in touch.

Contact details, links to the official source and the notes our team adds after checking each listing by hand.

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