Medical Director II, Utilization Management

Job Description A bit about this role:

This position interacts with utilization management, clinical management, pharmacy, network management, data analytics, legal, finance as well as other health plan departments. As a Medical Director in Utilization Management, you share responsibility for leadership in the appropriate use of medical services within established quality and evidenced based guidelines as well as executing the essential functions below:

• 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 work groups 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.

• 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.

• Passionate about their work, eager to have fun with our team, motivated to be a part of a fast growing organization.

• Excited by the process of developing and implementing new processes.

• Belief that population health and a focus on smart allocation of scarce resources can lead to high value care both in terms of quality and safety.

• Ability to remain calm in the midst of the storm, guiding others to smart, effective solutions

• Comfort with ambiguity and a love for problem solving.

#LI-Remote

Salary Range: $280,000 - $345,000 / year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

• 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....

* Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce.

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical…