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