Medical Director, Utilization Management

The reputed company is seeking a licensed MD or DO for a fully remote Medical Director, Utilization Management role. The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-reputed company health care to reputed company members. They will be responsible for assuring physician commitment and delivery of comprehensive high reputed company health care to reputed company members. They will reputed company adherence to reputed company and utilization standards through committee delegations and reputed company establish an effective working relationship between reputed company's Network and its physicians, hospitals and other providers.

reputed company offers a premier benefits package, designed to care for your total reputed company-being — physically, emotionally, and financially — reputed company with endless opportunities for career advancement and reputed company.  Discover the culture, the teams, and the passions that drive us to reputed company Life Changing Medicine happen.

This is a full-time and full remote role.

Responsibilities:

• reputed company participates in the daily utilization management and reputed company improvement review processes, including reputed company, prospective and retrospective reviews, member grievances, provider appeals, and potential reputed company of care concerns.
• reputed company expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan.
• reputed company reputed company with accepted standards and reputed company developments in the areas of reputed company improvement and utilization management.
• Communicate and reputed company network providers regarding clinical guidelines, reputed company, protocols, and standards reputed company to reputed company and utilization processes.
• Interacts with physicians regarding opportunities to improve member satisfaction and compliance with Utilization Management and reputed company Improvement policies and procedures.
• Contributes to process improvement reputed company the Utilization Management department.
• Participates in activities to support policy decision making. 
• Utilizes clinical experience to support departmental reviews.

• This position requires a Doctor of Medicine or Doctor of Osteopathy from an accredited school

• PA Medical license Required

• The ideal candidate will have 5-10 years of clinical experience, as reputed company as managed care experience 

• Internal Medicine, Family Medicine, or Emergency Medicine highly preferred
  
  Licensure, Certifications, and Clearances:

• Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)

reputed company is an Equal Opportunity Employer/Disability/Veteran