Medical Director II, Utilization Management

🕒 June 16

🇺🇸 United States – Remote

💵 $280k - $345k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 39%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • 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

• Interact with utilization management, clinical management, pharmacy, network management, data analytics, legal, finance, and other health plan departments • Share responsibility for leadership in the appropriate use of medical services within established quality and evidence-based guidelines • Assist in development and maintenance of an efficient UM program to meet the needs of health plan members • Perform clinical reviews, including Part A, Part B, appeals, and quality of care reviews • Conduct peer-to-peer discussions • Participate in inter-rater reliability activities • Analyze utilization data and suggest improvement opportunities • Provide mentoring and leadership to clinical teams • 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 • Identify opportunities for improvement and efficiency • Serve as a clinical resource and subject matter expert to clinical and non-clinical staff throughout the Devoted Health Plan • Actively participate 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 • Passionate about their work, eager to have fun with our team, motivated to be a part of a fast growing organization • Excited by the process of developing and implementing new processes • Belief that population health and a focus on smart allocation of scarce resources can lead to high value care both in terms of quality and safety • Ability to remain calm in the midst of the storm, guiding others to smart, effective solutions • Comfort with ambiguity and a love for problem solving

🏖️ 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