Medical Director II – Utilization Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Aids in the creation and upkeep of an effective Utilization Management (UM) program tailored to fulfill the requirements of health plan members in alignment with the company's core values.

• Conduct clinical evaluations (such as Part A, B, appeals, and quality of care) and engage in peer-to-peer discussions.

• Actively participate in inter-rater reliability initiatives.

• Involve yourself in the analysis of utilization data and propose opportunities for enhancement.

• Offer appropriate mentorship and leadership to clinical teams while fostering relationships to promote growth and financial accountability.

• Engage in committees and workgroups aimed at fulfilling departmental and corporate goals.

• Provide clinical assistance and take part in utilization management, quality management, clinical services, and care management programs to pinpoint areas for improvement and efficiency.

• Act as a clinical resource and subject matter expert for both clinical and non-clinical personnel across the Devoted Health Plan.

• Participate actively in acute and post-acute clinical rounds.

• Discuss with physicians within the Devoted network about medical policies, utilization management, resource utilization, and quality.

⛳️ Requirements

• A Doctorate from an accredited medical school (M.D.) or osteopathic school (D.O.) is required.

• At least five years of clinical practice experience.

• A minimum of three (3) years of previous experience as a medical director in a health plan, medical group, or hospital focusing on utilization management or medical management.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plan with minimal or no premium.

• Generous paid time off.

• $100 monthly stipend for mobile or internet expenses.

• Stock options available for all employees.

• Bonus eligibility for all positions except for Director and above; commission eligibility for sales roles.

• Parental leave program.

• 401K program.

• And more....