Utilization Management Medical Director (Medtech)

TL;DR

Utilization Management Medical Director (Medtech): Performing clinical reviews and peer-to-peer discussions for Medicare members with an accent on utilization management and quality of care. Focus on serving as a clinical subject matter expert and participating in acute and post-acute clinical rounds to improve member health outcomes.

Location: Must be based in the USA

Company

hirify.global is a healthcare company dedicated to improving the well-being of older Americans through an integrated care platform that combines advanced data and AI with world-class clinical services.

What you will do

• Perform clinical reviews including part A, B, appeals, and quality of care assessments.
• Conduct peer-to-peer clinical discussions.
• Participate in inter-rater reliability activities.
• Serve as a clinical resource and subject matter expert for clinical and non-clinical staff.
• Actively participate in acute and post-acute clinical rounds.

Requirements

• Must hold broad state licensure coverage in the USA.
• Must have experience in Medicare Utilization Management.
• Willingness to obtain additional state licenses.
• Comfort with learning and adapting to new technologies.

Culture & Benefits

• Fully remote work environment.
• Flexible schedule.
• Opportunity to work with a mission-driven team focused on improving healthcare for older adults.