Physician Supervisor, Utilization Management
$174,070–$374,920 year
On-siteIllinois, United States
Job Summary
Lead and manage the Utilization Management team by providing guidance, training, and support to resolve day-to-day issues while overseeing recruiting, hiring, and retention of skilled clinical staff. Conduct clinical reviews of medical records to determine medical necessity and appropriateness of care, ensuring timely processing of prior, concurrent, and retrospective authorizations. Monitor team performance through regular evaluations and coaching, while ensuring full compliance with federal, state, and local regulations. Collaborate with Transitions, Case Management, and Care Teams to facilitate coordinated resource utilization and serve as a clinical advisor. Maintain current knowledge of healthcare regulations and standards affecting UM practices.
Required Qualifications
- At least 2 years experience providing Utilization Management services to a Medicare and/or Medicaid line of business
- Excellent verbal and written communication skills
- A current, clinical, unrestricted license to practice medicine in the United States. (NCQA Standard)
- Graduate of an accredited medical school. M.D. or D.O. Degree is required. (NCQA Standard)
- 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 practice area and needed to maintain licensure)
- Demonstrated understanding of culturally responsive care
- Proven organizational and detail-orientation skills
- Ability to collaborate effectively with a staff, providers, and a diverse group of leaders
- US work authorization
Desired Qualifications
- Prior clinical leadership or supervision experience is preferred.
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