Per Diem Health Plan Um Medical Director

Mass General Brigham Incorporated

Somerville, MA, United States
Fully remote
Utilization management experience
Medicare and masshealth policies
Peer to peer case discussions
Mass General Brigham Health Plan UM Medical Director handles utilization management initial determinations, appeals, and grievances within defined expertise

Job Summary

  • Mass General Brigham Health Plan UM Medical Director handles utilization management initial determinations, appeals, and grievances within defined expertise.
  • The role requires adherence to Medicare, MassHealth, NCQA, and Division of Insurance compliance requirements.
  • This is primarily a remote position with M-F 8:30-5pm EST hours, ensuring timely completion of assigned work.

Matching Summary

Mass General Brigham Health Plan UM Medical Director handles utilization management initial determinations, appeals, and grievances within defined expertise.

Skills & Requirements

Must-have

  • Utilization Management experience
  • Medicare and MassHealth policies
  • Peer to peer case discussions
  • Regulatory compliance
  • EHR and digital tools proficiency

Nice-to-have

  • Adaptable to business growth
  • Integrate diversity, equity, inclusion
  • Positive colleague relationships

Key Requirements

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

Work Rights

Not specified

Tailored Resume

Cover Letter