Physician Supervisor, Utilization Management
$174,070–$374,920 year
On-site · Alexandria, Virginia, United States
Job Summary
Oversee day-to-day Utilization Management (UM) processes and lead a team of UM physicians to ensure high-quality, cost-effective healthcare delivery. Responsibilities include clinical reviews of medical records to determine medical necessity and appropriateness of care, managing prior authorizations and concurrent/retrospective reviews, collaborating with healthcare providers to optimize resource use, and ensuring compliance with federal, state, and local regulations. Provide leadership, guidance, and professional development to the UM team; participate in recruitment, performance evaluations, and cross-department collaboration to ensure integrated care and a strong patient experience.
Required Qualifications
- At least 2 years experience providing Utilization Management services to a Medicare and/or Medicaid line of business
- Current, clinical, unrestricted license to practice medicine in the United States
- Graduate of an accredited medical school; M.D. or D.O. degree
- 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 communication skills (verbal and written)
- US work authorization
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