Physician Supervisor, Utilization Management
$174,070–$374,920 year
On-site · Illinois, United States
Job Summary
Physician Supervisor, Utilization Management leads and administers the UM team to ensure efficient evaluation of medical necessity and appropriate care, oversees medical record reviews, prior authorizations, and collaboration with providers; requires MD/DO, active US license, Medicare/Medicaid UM experience, and clinical leadership capabilities; role emphasizes leadership, compliance with regulations, and coordination with Transitions, Case Management, and Care Teams to deliver high-quality, cost-effective healthcare for Medicare/Medicaid populations. Responsibilities include staffing, performance evaluation, training, and professional development of UM clinicians; oversight of clinical reviews, utilization reviews, and ongoing quality improvement; strong communication and stakeholder collaboration skills; NCQA standards familiarity and commitment to culturally responsive care.
Required Qualifications
- At least 2 years experience providing Utilization Management services to a Medicare and/or Medicaid line of business
- A current, clinical, unrestricted license to practice medicine in the United States
- Graduate of an accredited medical school. M.D. or D.O. Degree is required.
- 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 licensure
- US work authorization
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