Medical Director II – Utilization Management

🔥 12 hours ago

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

• 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....