Medical Director - Utilization Management​/Care Management, Select Health

Job Description

Select Health, a regional health plan serving over a million members in Utah, Idaho, Nevada, and Colorado, seeks an experienced Medical Director with expertise in Utilization Management (UM), Care Management (CM), and health plan accreditation and other operational and regulatory functions.

The Medical Director of UM/CM reports directly to the Chief Medical Officer and leads UM and CM functions from a clinical perspective, ensuring high quality, appropriate, efficient, and compliant care services. The role blends oversight of UM and CM with Select Health strategies to ensure members receive coverage and services that are high quality, appropriate, efficient, and cost-effective.

• Strategic Leadership: Develop and implement UM and CM strategies using data analytics, technology, and cost-benefit analysis to optimize covered services and care management efforts.
• Policy & Process Development: Participate in the creation, revision, and enforcement of UM/CM policies, procedures, and protocols to meet regulatory and other accreditation requirements.
• Operational Oversight: From a clinical perspective, manage provider reviewers, concurrent reviews, prior authorizations, medical claims reviews, appeals, and grievances, and ensure timely and accurate service authorizations consistent with regulatory and accreditation standards.
• Efficiency & Innovation: Identify process improvements, redesign workflows, and implement processes including auto‑approvals, alternative site criteria evaluation, artificial intelligence solutions, and prior authorization efficiency to reduce administrative burden.
• Pro‑Active Care (Value‑based Care): Participate in system innovation opportunities such as risk‑based contracting and reduction of prior authorization to simplify administration and reduce abrasion for members and providers.
• Data & Trend Analysis: Monitor utilization trends, measure productivity metrics, and report on cost savings and quality outcomes across areas of responsibility.
• Provider & Vendor Management: Build and maintain strong relationships with Select Health‑required vendors and clinical teams to improve care quality and efficiency.
• Compliance & Quality: Ensure adherence to state/federal regulations, accreditation standards, and contractual obligations; conduct provider education and training as necessary to facilitate compliance and quality measures.
• Team Leadership: Supervise and mentor UM/CM staff, provide executive‑level guidance, and support workforce planning as needed.
• Special Projects: Lead initiatives to improve member/provider experience, reduce unnecessary services, and enhance clinical decision support.

• Leadership
• Communication
• Taking Initiative
• Performance management
• Process Improvements
• Teamwork
• Workflow optimization
• Process documentation
• Health plan operation
• Federal, state and local regulations
• Computer Literacy

• FTE: 1.0
• Salary: $332,300 – $377,400 based on relevant experience
• Eligibility for an annual leadership incentive opportunity based on system goals
• Possible sign‑on and relocation bonus when applicable

• Medical Doctor or Doctor of Osteopathic Medicine degree with Board Certification in Internal Medicine, Pediatrics, Family Practice, Psychiatry, or Emergency Medicine.
• Current MD or DO licensure within the State of Utah, Idaho, Nevada, or Colorado.
• Five years of experience in clinical practice.

• Experience in utilization management, care management, and/or policy work for a health plan or managed care organization.
• Previous management experience.
• Experience with financial and medical expense management.
• Understanding of health care delivery systems as they relate to government programs and agencies.
• Excellent communication skills, including ability to establish and maintain rapport with coworkers, providers, brokers, employers, plan members, and representatives/executives from other health‑care entities, government, regulatory bodies, and community stakeholders.

• Ongoing need to see and read information, documents, monitors, identify equipment and supplies, and assess member, provider, and coworkers’ needs.
• Frequent verbal communication and listening to understand spoken information and issues quickly and accurately.
• Frequent computer use for typing, accessing information, etc.

Select Health – Murray, Utah

Scheduled Weekly

Hours:

40

We provide a generous benefits package covering health, dental, vision, retirement, and wellness programs.

This is an equal‑opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

All positions are subject to close without notice.