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Job Description
Utilization Management - Medical Director Atlas Search
LLC - 4.6
New York, NY Job Details Full-time $200,000 - $225,000 a year 2 hours ago Benefits Health insurance Qualifications Appeals Strategic management Inpatient Doctoral degree Medicare Operations management Managed care organization experience Outpatient facility experience Case appeal in utilization management Medicare regulations Utilization management Centers for Medicare and Medicaid Services (CMS) Resource utilization in healthcare Medical License Concurrent review in utilization management Medicaid regulations Internal medicine Medicaid Insurance claims appeal handling Senior leadership Full Job Description New York Metro Area (Candidates Must Reside in NY, NJ, or CT) Full-Time |
Hybrid Leadership Opportunity Total Compensation Range:
$200k - $225k We are seeking an experienced Medical Director of Utilization Management to provide clinical leadership within a growing health plan environment serving Medicare and Medicaid populations. This is an outstanding opportunity for a physician who enjoys collaborating across multidisciplinary teams, driving quality outcomes, ensuring regulatory compliance, and helping members receive the right care at the right time. What You'll Do Serve as the physician leader and clinical resource for Utilization Management operations. Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations. Partner with executive leadership to develop and execute medical management initiatives. Monitor utilization trends and identify opportunities to improve quality, efficiency, and cost-effectiveness. Participate in interdisciplinary care planning discussions to support coordinated member care. Ensure compliance with federal, state, accreditation, and contractual requirements. Support organizational readiness for audits, surveys, regulatory reviews, and investigations. Utilize care management platforms to document clinical reviews and decision-making activities. Evaluate utilization data and performance metrics to support strategic planning efforts. Contribute to annual departmental goals and provide ongoing progress updates. Maintain current knowledge of evolving Medicare, Medicaid, and managed care regulations. Collaborate with quality, care management, pharmacy, and operational teams to improve health outcomes. Required Medical Doctor (MD or DO) degree, licensed in NY. Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or related specialty. 3+ years of experience in health plan medical management. Experience supporting Medicare and Medicaid products, including managed care populations. Background in utilization management across inpatient and outpatient settings. Experience performing appeals reviews and medical necessity determinations. Strong knowledge of New York healthcare market dynamics. What Makes You Successful Strategic thinker with strong clinical judgment. Excellent communicator who can build relationships across departments. Data-driven leader focused on quality improvement and member outcomes. Strong understanding of healthcare regulations and managed care operations. Passion for improving access, affordability, and quality of care. SEO Keywords Medical Director, Utilization Management, Physician Executive, Medical Management, Managed Care, Medicare, Medicaid, MLTC, MAP, MAPD, D-SNP, Appeals Review, Peer-to-Peer Review, Population Health, Value-Based Care, Health Plan Leadership, New York Physician Jobs --- Atlas Search is a tri-state area recruitment agency, connecting new graduates, Advanced Practice Providers, Physicians and Nurse Leaders to hospitals, clinics, multi-specialty groups, nursing homes, managed care companies, private practices, and healthcare start-ups. If you would like to learn more about the opportunities we offer, please submit your CV for consideration here. #
IndeedHC Pay:
$200,000.00 - $225,000.00 per year Application Question(s): What is the best phone number and email address to reach you?
