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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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