Southeast Medical Group

Manager

• Monitor, evaluate, and optimize healthcare utilization across a network of independent provider practices
• Identify utilization trends, uncover drivers of high spend, and implement actionable strategies in collaboration with clinicians, patients, and senior leadership
• Conduct reviews for medical necessity and the utilization of ancillary services to ensure the appropriate level of patient care
• Collaborate with Analytics Team to leverage claims data, population health reports, and EMR data
• Develop and lead a strong UM team to support multiple payers, ACOs, and physician practices
• Conduct targeted outreach to share actionable, data-driven insights; highlight opportunities to reduce unnecessary utilization
• Identify high-risk, high-cost patients using claims and analytics tools
• Partner closely with the Medical Director to review complex cases and utilization patterns
• Track and report on utilization trends, interventions, and outcomes.

Manager, Utilization Management