Medical Director

Company

Cynet Systems

Location

Somerville, United States

Type

Full-time

 Job Description:
 
 Pay Range: $140hr - $145hr  Requirement/Must Have: 
 Ability to meet regulatory and compliance timelines. 
 Strong knowledge of utilization management, medical necessity determinations, and quality standards. 
 Experience: Experience handling utilization management determinations, appeals, and grievances. 
 Experience reviewing clinical services and quality incidents requiring physician involvement. 
 Experience collaborating on medical policy development and technology assessments. 
 Responsibilities: Perform utilization management initial determinations, appeals, and grievance reviews within regulatory and accreditation guidelines. 
 Review serious clinical services cases and quality incidents requiring physician oversight. 
 Provide medical necessity determinations supporting investigations related to fraud, waste, and abuse. 
 Collabor...
        

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