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Arthur Lawrence is looking for a Medical Director one of our clients in Somerville MA.
Requirements:
Experience performing utilization management determinations, appeals, and grievances in compliance with Medicare, MassHealth, NCQA, and DOI requirements
Strong background in medical necessity review, quality incident evaluation, fraud/waste/abuse support, and health plan medical policy development
Proven ability to collaborate with clinical, finance, quality, and network teams to improve care quality, control costs, and ensure regulatory compliance
Nice to have:
Experience assessing new and emerging medical technologies for coverage decisions
Background representing a health plan in external forums, delivering clinician education, or working closely with provider networks