Description
Select Health, a regional health plan with over a million members serving all lines of business in Utah, Idaho, Nevada, and Colorado, is seeking 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 Utilization Management/Care Management, reporting directly to the Chief Medical Officer, leads the UM and CM functions for Select Health from a clinical perspective, ensuring that care services are high-quality, appropriate, efficient, and in compliance with regulatory and accreditation standards.
Key Responsibilities:
- Develop and implement UM and CM strategies using data analytics, technology, and cost-benefit analysis to optimize covered services and care management efforts.
- Participate in the creation, revision, and enforcement of UM/CM policies, procedures, and protocols to meet regulatory and other accreditation requirements.
- Manage provider reviewers, concurrent reviews, prior authorizations, medical claims reviews, appeals, and grievances from a clinical perspective.
- Identify process improvements, redesign workflows, and implement processes to reduce administrative burden.
- Participate in system innovation opportunities such as risk-based contracting and prior authorization efficiency.
- Monitor utilization trends, measure productivity metrics, and report on cost savings and quality outcomes.
- Build and maintain strong relationships with vendors and clinical teams.
- Ensure adherence to state/federal regulations, accreditation standards, and contractual obligations.
- Supervise and mentor UM/CM staff, provide executive-level guidance, and support workforce planning.
Requirements:
- Medical Doctor or Doctor of Osteopathic Medicine degree with Board Certification in one of the following areas: 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.
Preferred Qualifications:
- Utilization management, care management, and/or experience in policy-related work for a health plan or managed care organization.
- Previous management experience.
- Experience with financial and medical expense management.
- Understanding of healthcare delivery systems as they relate to government programs and agencies.
- Excellent communication skills.
Benefits:
- Salary: $332,300 - 377,400 based on relevant experience.
- Eligible for an annual leadership incentive opportunity.
- Sign-on and relocation bonus may be offered.
- Comprehensive benefits package.