Working with departmental medical review nurses, the Associate Medical Director (
) for Medical Management reviews requests, to approve or deny, for medical services and confinements using clinical judgment, evidence based standards and organizational policies; decisions are then communicated to the medical review staff. The
evaluates and renders decisions on appeals of medical necessity denials. This position is responsible for daily utilization decisions but may assist in the development of medical policy, development of data to support policy change and special medical management projects under the direction of Senior Staff.
Medical Doctorate required
Board Certified Physician licensed to practice in NYS
MPH or MBA preferred
5+ years related experience required
Prior clinical practice experience required
Managed Care experience required
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From humble beginnings in a 14-zip code area of Brooklyn in 1993, to presence in all 62 counties of New York State today, Fidelis Care's...