Medical Director - Boston
1 month ago

Job Summary
The Medical Director will report to the Senior Medical Director of Utilization Management and support the staff of the Office of Clinical Affairs in the areas of medical management daily medical necessity reviews evaluation of medical policy utilization trend management quality appeals and grievances and pharmacy reviews.We are committed to diversity and inclusion WellSense participates in the E-Verify program to electronically verify employment eligibility We offer competitive salaries excellent benefits full-time remote work a growing regional health insurance company with a 25-year history providing health insurance that works for our members no matter their circumstances.
- Provides clinical case review consultation oversight all utilization management activities compliant federal state NCQA requirements.
- Conducts review prior authorizations concurrent retrospective medical necessity reviews determines coverage.
Job description
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