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:

Your Responsibilities and Impact will include:

• 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 workgroups 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.
  

Required skills and 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.

Desired skills and experience:

• 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.

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.

Our Total Rewards package includes:

• 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.

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.