Per Diem Health Plan Um Medical Director

Mass General Brigham Incorporated

Somerville, MA, United States
Fully remote
Utilization management initial determinations
Peer to peer case discussions
Medical necessity policies
Mass General Brigham Health Plan UM Medical Director handles utilization management initial determinations, appeals and grievances within the scope of their expertise as defined by Medicare, MassHealth, NCQA and the Division of Insurance

Job Summary

  • Mass General Brigham Health Plan UM Medical Director handles utilization management initial determinations, appeals and grievances within the scope of their expertise as defined by Medicare, MassHealth, NCQA and the Division of Insurance.
  • The role involves completing peer to peer case discussions with requesting providers and interacting, communicating and collaborating with network and community physicians, hospital leaders and other vendors.
  • This is primarily a remote position requiring adherence to regulatory timelines and active participation in work queues, email, and Teams messages during assigned work hours.

Matching Summary

Mass General Brigham Health Plan UM Medical Director handles utilization management initial determinations, appeals and grievances within the scope of their expertise as defined by Medicare, MassHealth, NCQA and the Division of Insurance.

Skills & Requirements

Must-have

  • Utilization Management initial determinations
  • peer to peer case discussions
  • medical necessity policies
  • regulatory timelines

Nice-to-have

  • positive relationships with colleagues
  • diversity equity and inclusion
  • adaptable to change

Key Requirements

  • MD or DO required
  • Massachusetts active full license required
  • 5+ years Health Plan UM experience
  • 5+ years clinical practice experience

Work Rights

Not specified

Tailored Resume

Cover Letter