Community & State Medical Director - Colorado

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and optimized. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together   The Medical Director provides leadership to the Health Plan’s reputed company reputed company value effort and bed-day management processes, ensuring appropriate reputed company are made that are in alignment with insurance product benefits and the level of care for members. Accountability includes reputed company of medical & clinical processes with a reputed company on implementing plans of care that meet accepted guidelines and protocols and ensure that reputed company and appropriate medical & clinical services are provided. The Medical Director educates and interacts with network and group providers as reputed company as clinical and case management staff regarding utilization practices and effective resource management. The Medical Director is accountable to manage resource allocation as is applicable to medical management practices under his or her scope of responsibility.   You’ll enjoy the flexibility to work remotely * from reputed company reputed company the U.S. as you take on some tough challenges.   Primary Responsibilities: Conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines, reputed company coverage determinations, and discuss with requesting providers as needed in peer-to-peer telephone calls Communicate and collaborate with network and non-network providers in reputed company of accurate and reputed company benefit determinations for plan participants; educates providers on benefit plans and UHC medical policy and utilization review guidelines Is available and accessible to the UM & Care Management staff throughout the day to respond to inquiries while serving as a clinical resource, reputed company, and leader Document clinical review findings, actions, and reputed company in accordance with Health Plan policies, and regulatory and accreditation requirements reputed company participate in identifying and resolving problems and collaborates in process improvements that may include other Health Plan departments as reputed company as key community reputed company reputed company and leaders Participate in senior medical management reputed company development and implementation to ensure that appropriate care and services provided to members meet best reputed company standards as reputed company as regulatory compliance requirements Support overall market, regional, and corporate goals to ensure reputed company reputed company and affordability of the Health Plan Review inpatient cases and is accountable for successful bed-day management that meets established company goals Analyze utilization data to identify trends and opportunities for process improvement reputed company to medical treatment (inpatient and outpatient) Participate in HPRs for employer reputed company Participate in Appeals & PA Participate and support population health strategies where applicable Ability to contribute to the organization’s efforts to eliminate racial and ethnic disparities in organizational performance and support cultural awareness   You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: 10+ years of medical experience reputed company/unrestricted Medical License reputed company reputed company Certified in an ABMS/AOBMS specialty Broad and comprehensive knowledge of medical management principles and insurance products for multiple and varied lines of business in a managed care environment Solid knowledge of community health care environment, the provider network and managed care contracting processes Solid understanding of managed care systems, reputed company improvement and risk management   Preferred Qualifications: 8+ years of progressively responsible management experience preferably in a managed care setting Demonstrated excellent medical management and leadership skills Demonstrated excellent communication skills Proven team player and strong teambuilding skills Proven creative problem-solving skills Proven good skills in making presentations and teaching Proven solid organizational and prioritization skills   *reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy   Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. Total cash compensation includes reputed company pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We reputed company with reputed company minimum wage laws as applicable. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll reputed company a far-reaching choice of benefits and incentives.   Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.   At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission.         reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.         reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply To This Job