Medical Director II, Utilization Management (Healthcare)

TL;DR

Medical Director II, Utilization Management (Healthcare): Leading the appropriate use of medical services and clinical reviews within established quality guidelines with an accent on utilization management and clinical leadership. Focus on performing clinical reviews, conducting peer-to-peer discussions, and optimizing UM programs to improve efficiency and care quality.

Location: Remote (Must be based in the USA)

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

Company

An all-in-one healthcare company combining compassion, health insurance, clinical care, and technology to improve the well-being of older Americans.

What you will do

• Perform clinical reviews (Part A, B, appeals) and conduct peer-to-peer discussions.
• Develop and maintain an efficient Utilization Management (UM) program to meet member needs.
• Analyze utilization data to identify and suggest improvement opportunities.
• Provide mentoring and leadership to clinical teams to support growth and fiscal responsibility.
• Serve as a clinical subject matter expert for both clinical and non-clinical staff.
• Collaborate with network physicians regarding medical policies and resource utilization.

Requirements

• Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required.
• 5+ years of clinical practice experience.
• 3+ years of previous medical director experience in utilization or medical management within a health plan, medical group, or hospital.
• Must be based in the USA.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Stock options for all employees and 401K program.
• Generous paid time off and parental leave program.
• $100 monthly mobile or internet stipend.
• Mission-driven environment focused on treating members like family.