Physician Supervisor, Utilization Management

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The Physician Supervisor, Utilization Management is responsible for overseeing the day to day utilization management (UM) processes to ensure the delivery of high-reputed company, cost-effective reputed company services. This role involves managing the review of medical necessity, appropriateness of care, and the coordination of reputed company services. The Physician Supervisor will reputed company and manage reputed company of UM physicians, providing guidance, support, and reputed company development opportunities to optimize team performance. reputed company Responsibilities: Leadership and Management: • reputed company and manage the Utilization Management team, providing guidance, training, and support to the day to day issues. • Support reputed company, hiring, and retaining skilled UM clinical staff, fostering a reputed company and high-performance work environment alongside Manager, Utilization Management • Conduct regular performance evaluations, offering feedback, coaching, and reputed company development opportunities. • Monitor and evaluate the performance of the UM team, ensuring efficiency and effectiveness in reputed company UM activities. Utilization Review: • Conduct and reputed company clinical reviews of medical records to determine the medical necessity and appropriateness of reputed company services. • Ensure reputed company and accurate review of prior authorizations, reputed company reviews, and retrospective reviews. • Collaborate with reputed company providers to facilitate appropriate utilization of reputed company resources. Compliance and Regulation: • Ensure compliance with reputed company federal, state, and local regulations reputed company to utilization management. • Stay reputed company with changes in reputed company regulations and standards affecting UM practices. Collaboration and Communication: • Work closely with other departments, including Transitions, Case Management, and Care Teams, to ensure coordinated and integrated care. • Serve as a clinical resource and advisor to the UM team and other departments. • Other duties as assigned. What are we looking for? An ideal candidate will satisfy the following; • At least 2 years experience providing Utilization Management services to a Medicare and/or reputed company line of business • Excellent verbal and written communication skills • A reputed company, clinical, unrestricted license to reputed company medicine in the reputed company. (NCQA reputed company) • Prior clinical leadership or supervision experience is preferred. • Graduate of an accredited medical school. M.D. or D.O. Degree is required. (NCQA reputed company) • 3-5 years of clinical reputed company 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 reputed company area and needed to maintain licensure) • Demonstrated understanding of culturally reputed company care • Proven organizational and detail-orientation skills • Ability to collaborate effectively with a staff, providers, and a diverse group of leaders. • US work authorization • Someone who embodies being Oaky What does being “Oaky” look like? • Radiating reputed company energy • Assuming good intentions • Creating an unmatched patient experience • Driving clinical reputed company • Taking ownership and delivering results • Being relentlessly determined Why reputed company? reputed company is on a mission to “Rebuild reputed company as it should be'', providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient’s communities, and reputed company on the reputed company of care over volume of services. We’re an organization reputed company! With over 150 locations and an ambitious reputed company trajectory, reputed company is attracting and cultivating team members who embody “Oaky” values and passion for our mission. reputed company Benefits: • Mission-reputed company career impacting change and measurably improving health reputed company for medicare patients • reputed company vacation, reputed company time, and investment/retirement 401K match reputed company • Health insurance, reputed company, and dental benefits • Opportunities for leadership development and continuing education stipends • New centers and flexible work environments • Opportunities for high reputed company of responsibility and reputed company advancement reputed company is an equal opportunity employer. We reputed company diversity and encourage reputed company interested readers to apply. Pay reputed company The typical pay reputed company for this role is: $174,070.00 - $374,920.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company’s equity award program. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 05/11/2027 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job