Per Diem Health Plan Um Medical Director

Mass General Brigham Incorporated

Boston, MA, US
Fully remote
Utilization management initial determinations
Peer to peer case discussions
Collaborate with network physicians
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 830-5pm 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
  • collaborate with network physicians
  • monitor performance metrics
  • integrate diversity, equity, and inclusion

Nice-to-have

  • adaptable to business growth
  • positive relationships with colleagues

Key Requirements

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

Work Rights

Not specified

Tailored Resume

Cover Letter