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What You Will Do:
- Conduct timely medical necessity determinations for inpatient admissions and post-acute settings.
- Use evidence-based guidelines and CMS criteria to assess the appropriateness of acute care services.
- Partner with utilization and care management teams to ensure consistent, cost-effective care.
What You Will Bring:
- Licensed M.D. or D.O. in good standing in your state of residence.
- At least 3 years in a utilization management or medical leadership role within a managed care or health plan setting.
- Strong experience in inpatient/post-acute case review and deep knowledge of Medicare Advantage regulations and CMS coverage criteria.
HJ Staffing
HJ Staffing is seeking a Medical Director of Utilization Management to join a leading Medicare Advantage Health Plan. The company has not provided any information about its size/employees and culture but is likely a medium to large medical or staffing company.