The Judge Group
I have a
remote opportunity for an experienced Medical Director to support Utilization Management (UM) operations , including pre-certification review and physician-to-physician (peer) consultations with one of Pennsylvania's top clients.
Key Responsibilities Conduct Utilization Management reviews, including pre-certification, concurrent review, and retrospective review as needed. Perform peer-to-peer discussions with ordering providers to clarify clinical information and determine medical necessity. Apply InterQual, CMS guidelines, and other evidence-based criteria to clinical determinations. Maintain strict compliance with confidentiality requirements and CMS regulations.
Other Highlights yearly earnings $280,000+ Monday to Friday schedule, no weekends
Required Qualifications Doctor of Medicine (MD) or Doctor of Osteopathy (DO) with active, unrestricted Pennsylvania medical license. Board Certified in Internal Medicine. Minimum 2+ years of Utilization Management experience, including pre-cert and peer review. Demonstrated experience using InterQual criteria and CMS medical necessity guidelines. Must reside in PA, NJ, or DE. Must not be concurrently employed or consulting with Jefferson or Penn.
APPLY NOW.
remote opportunity for an experienced Medical Director to support Utilization Management (UM) operations , including pre-certification review and physician-to-physician (peer) consultations with one of Pennsylvania's top clients.
Key Responsibilities Conduct Utilization Management reviews, including pre-certification, concurrent review, and retrospective review as needed. Perform peer-to-peer discussions with ordering providers to clarify clinical information and determine medical necessity. Apply InterQual, CMS guidelines, and other evidence-based criteria to clinical determinations. Maintain strict compliance with confidentiality requirements and CMS regulations.
Other Highlights yearly earnings $280,000+ Monday to Friday schedule, no weekends
Required Qualifications Doctor of Medicine (MD) or Doctor of Osteopathy (DO) with active, unrestricted Pennsylvania medical license. Board Certified in Internal Medicine. Minimum 2+ years of Utilization Management experience, including pre-cert and peer review. Demonstrated experience using InterQual criteria and CMS medical necessity guidelines. Must reside in PA, NJ, or DE. Must not be concurrently employed or consulting with Jefferson or Penn.
APPLY NOW.