Growing integrated healthcare provider seeks a Director of Medical Utilization - MD to lead the company's utilization management clinical team. The Director of Medical Utilization - MD will manage other utilization management clinical teams, including physicians and nurses. All candidates should have a depth of experience in HEDIS, Medicare and Medicaid guidelines.
Our healthcare clients seek physician leaders for medical utilization who are career-driven, have strong management and analytical skills and a depth of experience in managing case review and peer review. Our companies offer strong career growth potential and benefits. We have many opportunities - all with top healthcare companies seeking the best in physician leadership.
typical roles and responsibilities for Director Medical Utilization – MD
- Oversee daily utilization management activities including reviewing requests and making coverage determinations for services and supplies for delegated lines of business.
- Act in a supporting role as medical manager and policy advisor to the company and our clients.
- Execute the Utilization/Cost Management Programs and relevant Clinical Quality Improvement Programs in partnership with the Director, Care Management and Market Medical Directors
- Interface with provider community on Utilization Management and evidence based medicine
- Provide education to provider teammates in local markets and to the UM team regarding managed care processes as well as clinical issue
Requirements for the Director of Medical Utilization MD
- M.D. graduate of an accredited medical school, MBA or advanced degree in healthcare management preferred
- U.S. M.D. licensure
- BC or BE in either internal medicine, family medicine, radiology, orthopedics, cardiology or geriatrics
- 2+ years experience as a physician reviewer performing peer review activities.
- A working understanding of Medicare/Medicaid guidelines
- 3+ years experience in clinical practice
- Progressive medical administration experience strongly preferred
- Proven ability in a medical leadership position in clinical credibility with experience developing and guiding team members
- A strong understanding of all aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient-centered medical home concepts.
- Strong interpersonal, verbal, and written communication skills.
- The ability to navigate in a corporate matrix environment
Salary range for Director Medical Utilization – MD