Associate Medical Director, Utilization Management Review

Completed US-based residency program and fellowship in Internal Medicine Board certification as an MD or DO with a current unrestricted state license to practice medicine 5+ years of clinical practice beyond residency/fellowship in Internal Medicine Comfortable with technology and learning new software tools Understanding of managed care regulatory structure and processes Detail-oriented, flexible, and able to work autonomously 1+ years of managed care utilization review experience desirable Licensure in AZ, FL, MS, NC, ND, OK, OR, TX is highly desirable Subspecialty fellowship training in Hematology Oncology, Medical Oncology, Gastroenterology, Endocrinology, Urology, or Sleep Medicine desirable

Support the clinical content team in reviewing clinical decision guidelines. Provide expert input on content for influencing physicians. Provide timely medical reviews that meet quality and timeliness parameters. Provide clinical determinations based on evidence-based criteria. Document all communication and decision-making in workflow tools. Conduct timely peer-to-peer discussions with treating providers.