Assists in development and maintenance of an efficient UM program to meet the needs of health plan members commensurate with company values.
Perform clinical reviews (i.e., part A, B, appeals, quality of care) and conduct peer to peer discussions.
Participate in inter-rater reliability activities.
Participate in analysis of utilization data and suggest improvement opportunities.
Provide appropriate mentoring and leadership to clinical teams as well as develop relationships to support growth and fiscal responsibility.
Participate in committees and workgroups to achieve department and corporate objectives.
Provide clinical support and participate in utilization management, quality management, clinical services and care management programs to identify opportunities for improvement and efficiency.
Serves as a clinical resource and subject matter expert to both clinical and non-clinical staff throughout the Devoted Health Plan.
Active participation in acute and post acute clinical rounds.
Conduct discussions with physicians in the Devoted network regarding: medical policies, utilization management, use of resources, and quality.

Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O) required.
Five or more years of clinical practice experience.
Three (3) years of previous medical director experience working for a health plan, medical group, or hospital in utilization management or medical management.

Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....

Medical Director II, Utilization Management

Key skills