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Job Description

Arthur Lawrence is looking for a Medical Director one of our clients in Somerville MA. Please find the job description below and send us your updated resume if interested:

Must-Have Skills:

Experience performing utilization management determinations, appeals, and grievances in compliance with Medicare, MassHealth, NCQA, and DOI requirements.
Strong background in medical necessity review, quality incident evaluation, fraud/waste/abuse support, and health plan medical policy development.
Proven ability to collaborate with clinical, finance, quality, and network teams to improve care quality, control costs, and ensure regulatory compliance.

Nice to Have Skills:

Experience assessing new and emerging medical technologies for coverage decisions.
Background representing a health plan in external forums, delivering clinician education, or working closely with provider networks.

About Us:

Arthur Lawrence is a management and technology consulting firm providing enterprise-wide business transformation and business applications implementation services to Fortune 100 and Big 4 organizations. Our in-depth technical knowledge and broad experience in working with world-class companies enable organizations to leverage our capabilities in developing winning strategies and cost-effective solutions.

We are a UN Women Empowerment Principal Signatory and are certified by National Minority Supplier Development Council.

Recent Associations & Acknowledgments:

Been recognized as a 2023 TOP WORKPLACE by the Houston Chronicle
IAOP Award; Ranked in the top 100 internationally
Ranked among the Inc 5000 twice - as one of the FASTEST GROWING COMPANIES OF AMERICA
Member of HMSDC, NMSDC and NY&NJMSDC

Our Seven Pillars:

We rely on the seven core values that we believe enable us to deliver quality for our consultants and clients: Education, Integrity, Value Creation, Collaboration, Best Client, Best People, and Stewardship. Through strict adherence to these core values, we have achieved success beyond all documented forecasts and anticipation.

#dicejobs

Travel Required

Yes

About Arthur Lawrence

Arthur Lawrence is a management and technology consulting firm providing enterprise-wide business transformation and business applications implementation services. Our in-depth technical knowledge and broad experience of working with world-class companies enables organizations to leverage our capabilities in developing winning strategies and cost-effective solutions. We are an UN Women Empowerment Principal Signatory and are certified from National Minority Supplier Development Council.