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REMOTE : Medical Director, Utilization Management and Medical Policy
Evry HealthTX, United States- Promoted
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ProvidenceTX, United StatesREMOTE : Medical Director, Utilization Management and Medical Policy
Evry HealthTX, United States- Full-time
- Remote
About the Role
Evry Health is hiring a tech-savvy Medical Director to lead medical policy and utilization management. As a physician, you will work with the actuarial, technology, medical care coordination, and medical quality management teams. You will report directly to the Chief Medical Officer.
About Evry Health and Globe Life
We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives.
Evry Health is the major medical division of Globe Life (NYSE : GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.
Key Responsibilities
- Utilization management.
- Medical policy.
- Leading, and working with, the Utilization Management Review Committee.
- Development of new medical policies.
- Incorporating regulatory updates, and care guideline updates into medical policy.
- Medical oversight, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members.
- Promote positive relations with the local medical community, including periodic consultation with providers, facilities, care givers, etc.
- Reviews case management data, identifies trends and gaps in care and recommends corrective actions.
- Provides oversight and direction for staff and provider training and education.
- Integration of clinical quality and demonstrated best clinical practices into medical management program development.
- Evaluates the development of new and continuation of existing programs. Investigates future care management and patient engagement technologies and evaluates their impact on providers’ practices, patient safety and patient experience.
Qualifications
Telecommuting Requirements
Location and Benefits
Employment Status
Minimum Required Education
Medical Specialty Required
Experience
To Apply