Director Medical Utilization – MD Job Description Template

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