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Key Responsibilities:
- Lead utilization management strategy, including oversight of medical necessity determinations and review processes.
- Own medical policy development and provide oversight for the Utilization Management Review Committee.
- Promote positive relations with the local medical community and review case management data to identify trends.
Clinical Leadership:
- Provide medical expertise to ensure delivery of cost-effective, quality healthcare services.
- Integrate clinical quality and best practices into medical management program development.
- Evaluate new programs and investigate future care management and patient engagement technologies.
Role Requirements:
- Must have an active, unrestricted Texas medical license and be a Doctor of Medicine with 8+ years of clinical experience.
- Requires board certification and experience working within a health insurance plan, with emphasis on managed care and utilization management.
- Position is remote but requires residence in the US within the Eastern or Central time zones and work during company business hours.
Evry Health
Evry Health is the major medical division of Globe Life, a technology-enabled health plan focused on expanding benefits and increasing transparency. It is part of Globe Life, a large insurance company with over 3,000 corporate employees and a long-standing A (Excellent) rating from A.M. Best.