- The Medical Director of Utilization Management is responsible for the evaluation of all outpatient referrals and inpatient direct admissions for medical appropriateness.
- He or she will utilize Interqual reviews as provided by Corizon Health’s utilization management nurses along with Corizon Health’s standard medical guidelines to determine whether a request will be approved as an offsite encounter or if an alternate treatment plan should be employed; alsotaking severity of illness, acuity and risk of mortality into account in making such determinations.
Experience & Requirements
- US Residency completion required, and Board Certification preferred
- Five (5) years of progressively related work experience preferred
- Strong written and verbal communication skills
- Team oriented and a collaborative mindset
- Requires broad clinical knowledge with good clinical background, analytical and decision making skills
- Knowledge of health care delivery system
- Knowledge of utilization management, InterQual, DRGs
- Active licenses in multiple state contracts where services are provided