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 requires 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 with scheduled hours of M-F 8:30 AM - 5 PM EST, 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 the scope of their expertise as defined by Medicare, MassHealth, NCQA and the Division of Insurance.