Mass General Brigham Health Plan UM Medical Director handles utilization management initial determinations, appeals, and grievances within their scope of expertise
Job Summary
Mass General Brigham Health Plan UM Medical Director handles utilization management initial determinations, appeals, and grievances within their scope of expertise.
The role requires adherence to Medicare, MassHealth, NCQA, and Division of Insurance compliance requirements, using medical necessity policies for determinations.
This is primarily a remote position with M-F 8:30-5pm EST hours, ensuring all assigned work is completed within regulatory timelines.
Matching Summary
Mass General Brigham Health Plan UM Medical Director handles utilization management initial determinations, appeals, and grievances within their scope of expertise.