Utilization Manager Medical Director - Casual
$222,750–$267,300 year
RemoteUnited States
Job Summary
Develop and implement Utilization Management policy and procedures, including criteria for authorization review and decision validation. Lead the Utilization Management Committee, Quality Management Committee, and Peer Review committees while interfacing with health plans on benefits, coverage, and appeals. Conduct clinical rounds with Case Managers to meet bed day performance goals and coordinate prospective, concurrent, and retrospective reviews for outside medical services. Facilitate physician education on UM systems and develop medical care protocols to standardize care. Serve as a resource for IDCT meetings and network physician engagement regarding cost containment and clinical appropriateness. This 1-month casual role requires operating Pacific Standard Time business hours.
Required Qualifications
- Doctor of Medicine degree
- valid California licensure
- Current Board certification, preferably in a broad based specialty such as Internal Medicine, Family Practice, Emergency Medicine, Geriatrics, General Surgery or Pediatrics
- A minimum of twelve (12) years as a practicing inpatient and outpatient physician in a managed care environment
- Interest and experience in utilization management and medical management
- You must be able to work operating business hours on Pacific Standard Time
- External hires must pass a background check/drug screen
Desired Qualifications
- Board certification in a broad based specialty such as Internal Medicine, Family Practice, Emergency Medicine, Geriatrics, General Surgery or Pediatrics
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