This is a fully remote position, open to applicants in Connecticut.

📋 Description

• Deliver clinical expertise and strategic direction to enhance medical management initiatives.

• Oversee all elements of utilization review and quality assurance, guiding case management efforts.

• Assist Medical Management personnel in providing prompt and consistent responses to both members and providers.

• Serve as the primary business and clinical liaison for network providers and facilities.

• Handle predetermination reviews and assessments of claim determinations, offering insights in clinical, coding, and reimbursement matters.

⛳️ Requirements

• A minimum of 2 years of experience within the Health Care Delivery System, such as Clinical Practice and the Health Care Industry.

• An active and current state medical license free from encumbrances.

• M.D. or D.O. with Board Certification in the Cardiology specialty, including relevant post-graduate direct patient care experience.

• Prior experience in healthcare insurance is preferred.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• A comprehensive benefits package tailored to support physical, emotional, and financial health.