Medical Director II, Utilization Management
Devoted Health
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $280,000 - $345,000 per year
Job Level
About the role
- Assists in development and maintenance of an efficient UM program to meet the needs of health plan members commensurate with company values.
- Perform clinical reviews (i.e., part A, B, appeals, quality of care) and conduct peer to peer discussions.
- Participate in inter-rater reliability activities.
- Participate in analysis of utilization data and suggest improvement opportunities.
- Provide appropriate mentoring and leadership to clinical teams as well as develop relationships to support growth and fiscal responsibility.
- Participate in committees and workgroups to achieve department and corporate objectives.
- Provide clinical support and participate in utilization management, quality management, clinical services and care management programs to identify opportunities for improvement and efficiency.
- Serves as a clinical resource and subject matter expert to both clinical and non-clinical staff throughout the Devoted Health Plan.
- Active participation in acute and post acute clinical rounds.
- Conduct discussions with physicians in the Devoted network regarding: medical policies, utilization management, use of resources, and quality.
Requirements
- Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O) required.
- Five or more years of clinical practice experience.
- Three (3) years of previous medical director experience working for a health plan, medical group, or hospital in utilization management or medical management.
Benefits
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
- And more....
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical reviewsutilization managementquality managementcare managementdata analysispeer to peer discussionsacute clinical roundspost acute clinical roundsmentoringleadership
Soft Skills
relationship buildingcommunicationteam collaborationfiscal responsibilityproblem solvinginterpersonal skillsorganizational skillsstrategic thinkingadaptabilitymentorship
Certifications
Doctorate in Medicine (M.D.)Doctorate in Osteopathy (D.O.)