Medical Director - Utilization Management
Location | United States |
Salary | $175,000Key Responsibilities:Strategic Leadership: Provide strategic direction and leadership for the Utilization Management department |
Remote | 🌴Remote allowed |
First listed | In the last 7 months |
Company Info | 👉 See Dane Street LLC company tax, EIN & IRS information |
Job Description
We are seeking an experienced and highly qualified Medical Director to join our team and lead our Utilization Management department. The Medical Director will be responsible for case/utilization management reviews, overseeing the utilization management process, and ensuring the efficient and effective use of healthcare resources while maintaining high standards of care. The successful candidate will play a crucial role in enhancing healthcare services and improving patient outcomes.
Annual Salary: $175,000
Key Responsibilities:
Strategic Leadership:
- Provide strategic direction and leadership for the Utilization Management department.
- Develop and implement utilization management strategies to optimize resource allocation.
Utilization Review:
- Oversee the utilization review process, including denials/appeals, pre-authorization, concurrent review, and retrospective review.
- Ensure compliance with regulatory requirements and industry standards
Quality Improvement:
- Collaborate with quality improvement teams to enhance the quality of healthcare services.
- Identify areas for improvement and implement quality improvement initiatives.
Clinical Oversight:
- Review and approve clinical guidelines and protocols for utilization management.
- Provide clinical expertise and guidance to the utilization management team.
Client Collaboration:
- Collaborate with healthcare entities to foster effective communication and cooperation.
- Address clinical concerns and provide recommendations for improving care delivery.
Data Analysis:
- Analyze utilization data and trends to identify opportunities for cost containment and improved outcomes.
- Develop data-driven recommendations for decision-making.
Team Management:
- Lead and mentor the utilization management team, including nurses and other healthcare professionals.
- Foster a positive and collaborative work environment.
Requirements
Qualifications:
- Medical Doctor (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree.
- Current, unrestricted medical license in the state of practice.
- Ability to obtain a license in MN.
- Board certification in a relevant specialty.
- Highly preferred - Previous experience in utilization management and healthcare administration.
- Strong knowledge of healthcare regulations and accreditation standards.
- Excellent leadership and communication skills.
- Strong analytical and problem-solving abilities.
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