Medical Director II, Utilization Management
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Job Description
Medical Director II in Utilization Management at Devoted Health, guiding clinical services within quality and evidence-based guidelines. Engaging with various departments to optimize medical service utilization.
Responsibilities:
- 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.
Requirements:
- Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O) required.
- Five or more years of clinical practice experience.
- Three (3) years of previous medical director experience working for a health plan, medical group, or hospital in utilization management or medical management.
Benefits:
- 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....
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