Medical Director - Utilization Review
Fidelis Care New York - New York, NY

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Working with departmental medical review nurses, the 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 Medical Director 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.

The successful candidate must be a board certified physician licensed to practice in New York with 5+ years of clinical experience. Managed Care experience is required, Utilization Review experience preferred.

We offer competitive compensation and comprehensive benefits.

To learn about current employment opportunities, please visit the employment section of our website:

Fidelis Care is fully committed to Equal Employment Opportunity and to attracting, retaining, developing and promoting the most qualified employees without regard to their race, gender, color, religion, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, or any other characteristic prohibited by state or local law.

HEALTHeCAREERS Network - 23 months ago - save job
About this company
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From its origin in 1993 as the Catholic Health Services Plan of Brooklyn and Queens, Inc., Fidelis Care has grown -- both in the scope of...