Physician Supervisor, Utilization Management

The Physician Supervisor, Utilization Management is responsible for overseeing the day-to-day utilization management (UM) processes to ensure the delivery of high-quality, cost-effective healthcare services. This role involves managing the review of medical necessity, appropriateness of care, and the coordination of healthcare services while leading and developing a team of UM physicians.

• Leadership and Management – Lead and manage the Utilization Management team, providing guidance, training, and support to daily issues. Support recruiting, hiring, and retaining skilled UM clinical staff. Conduct regular performance evaluations, offering feedback, coaching, and professional development opportunities. Monitor and evaluate the performance of the UM team, ensuring efficiency and effectiveness in all UM activities.
• Utilization Review – Conduct and oversee clinical reviews of medical records to determine medical necessity and appropriateness of healthcare services. Ensure timely and accurate review of prior authorizations, concurrent reviews, and retrospective reviews. Collaborate with healthcare providers to facilitate appropriate utilization of healthcare resources.
• Compliance and Regulation – Ensure compliance with all federal, state, and local regulations related to utilization management and stay current with changes in healthcare regulations and standards affecting UM practices.
• Collaboration and Communication – Work closely with other departments, including Transitions, Case Management, and Care Teams, to ensure coordinated and integrated care. Serve as a clinical resource and advisor to the UM team and other departments.
• Other duties as assigned.

• At least 2 years of experience providing Utilization Management services to a Medicare and/or Medicaid line of business.
• Excellent verbal and written communication skills.
• A current, clinical, unrestricted license to practice medicine in the United States (NCQA Standard).
• Prior clinical leadership or supervision experience is preferred.
• Graduate of an accredited medical school. M.D. or D.O. degree is required (NCQA Standard).
• 3–5 years of clinical practice in a primary care setting.
• Deep understanding of managed care, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, and pharmacy management.
• Strong record of continuing education activities relevant to practice area and needed to maintain licensure.
• Demonstrated understanding of culturally responsive care.
• Proven organizational and detail‑orientation skills.
• Ability to collaborate effectively with staff, providers, and a diverse group of leaders.
• US work authorization.

• Mission-focused career impacting change and measurably improving health outcomes for Medicare patients.
• Paid vacation, sick time, and investment/retirement 401(k) match options.
• Health insurance, vision, and dental benefits.
• Opportunities for leadership development and continuing education stipends.
• New centers and flexible work environments.
• Opportunities for high levels of responsibility and rapid advancement.

The typical pay range for this role is: $ – $. This represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short‑term incentive program in addition to the base pay range listed above.

This position also includes an award target in the company’s equity award program.

Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.