Medical Director in Utilization Management

Role Overview:

• Interacts with utilization management, clinical management, pharmacy, network management, data analytics, legal, finance as well as other health plan departments.
• Shares responsibility for leadership in the appropriate use of medical services within established quality and evidenced based guidelines.
• Serves as a clinical resource and subject matter expert to both clinical and non-clinical staff throughout the Devoted Health Plan.

Responsibilities:

• Assists in development and maintenance of an efficient UM program to meet the needs of health plan members commensurate with company values.
• Participate in analysis of utilization data and suggest improvement opportunities.
• Provide clinical support and participate in utilization management, quality management, clinical services and care management programs to identify opportunities for improvement and efficiency.

Required Experience:

• 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.