Per Diem Health Plan Um Medical Director

Mass General Brigham Incorporated

Unknown, Unknown, USA
Fully remote
Utilization management initial determinations
Peer to peer case discussions
Compliance requirements
Mass General Brigham relies on a wide range of professionals to advance our mission of patient care, research, teaching, and community service

Job Summary

  • Mass General Brigham relies on a wide range of professionals to advance our mission of patient care, research, teaching, and community service.
  • 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.
  • Primarily remote position, M-F 8:30-5pm EST, ensuring all assigned work is completed within regulatory timelines.

Matching Summary

Mass General Brigham relies on a wide range of professionals to advance our mission of patient care, research, teaching, and community service.

Skills & Requirements

Must-have

  • Utilization Management initial determinations
  • peer to peer case discussions
  • compliance requirements
  • regulatory timelines
  • work queues and email

Nice-to-have

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

Key Requirements

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

Work Rights

Not specified

Tailored Resume

Cover Letter