Medical Director, Utilization Management

Job Description

A bit about this role :

This position interacts with utilization management, clinical management, pharmacy, network management, data analytics, legal, finance as well as other health plan departments.

As a Medical Director in Utilization Management, you share responsibility for leadership in the appropriate use of medical services within established quality and evidenced based guidelines as well as executing the essential functions below :

Your Responsibilities and Impact will include :

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.

Required skills and experience :

Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O) required.

Five or more years of clinical practice experience.

Two (2) years of previous medical director experience working for a health plan, medical group, or hospital in utilization management or medical management.

Ability to work business hours in PST or MST time zones.

Desired skills and experience :

Passionate about their work, eager to have fun with our team, motivated to be a part of a fast growing organization.

Excited by the process of developing and implementing new processes.

Belief that population health and a focus on smart allocation of scarce resources can lead to high value care both in terms of quality and safety.

Ability to remain calm in the midst of the storm, guiding others to smart, effective solutions

Comfort with ambiguity and a love for problem solving.

Salary Range : $280,000 - $325,000 annually

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce.

If you lack a specific credential for this position but believe that your strengths and life experiences will propel our mission, we would love to hear from you.

Our Total Rewards package includes :

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....

Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

The salary and / or hourly range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.

When determining a team member's base salary and / or rate, several factors may be considered as applicable (e.g., location, specialty, years of relevant experience, education, credentials, budget and internal equity).

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business.

We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

Benefits

We strive to treat every Member like family and that mindset, applies to our teams too. Expect benefits that support your body,, mind, and well-being now and later.

Comprehensive health plan, 401K retirement plan, Generous vacation and holiday time, Lyra mental health resources, Stockoptions