Utilization Management Medical Director
CenterWell Senior Primary Care
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $223,800 - $313,100 per year
Job Level
About the role
- rely on medical background and review health claims
- provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards
- make decisions on moderately complex to complex issues regarding technical approach for project components
- exercise considerable latitude in determining objectives and approaches to assignments
Requirements
- MD or DO degree
- Three years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age)
- Current and ongoing board certification an approved ABMS medical Specialty, or other board demonstrating advanced training in transitions of care, quality assurance, utilization management and care coordination
- A current and unrestricted medical license in at least one jurisdiction and willing to obtain additional license
- No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
- Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on transitions of care, quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation.
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
- many other opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical interpretationhealth claims reviewclinical patient caretransitions of carequality assuranceutilization managementcare coordinationcase managementdischarge planninghome health services
Soft Skills
analytical skillsdecision makingteam collaborationproblem solvingcommunication skillsobjectives determinationapproach developmentperformance standards adherencelatitude in decision makingcomplex issue resolution
Certifications
MD degreeDO degreeboard certificationABMS medical specialty certificationmedical license