Per Diem Medical Director Utilization Management

**Job Summary**

Reporting to the Senior Medical Director of UM, the Per Diem UM Medical Director will be responsible for:

Performing daily medical reviews, appeals, participating in appeal panel as appropriate, correspondence regarding review determinations and physician peer review activities.
Identifying and implementing evidence-based practice guidelines throughout the provider network. · overseeing the quality of clinical care for network and non-network providers.
Utilizing evidence-based standards in making coverage determinations.
Management policies; meeting health plan inter-rater reliability guidelines.

**Work Arraignment:** Remote and not to exceed 15 hours per week, including rotating weekend and evening coverage as assigned.

**Accountabilities:**

+ Ensures the provision of quality and clinically sound services to all Enrollees by associates and Providers.
+ Serves as medical advisor and manager for all clinically re...