Medical Director - Utilization Management

Location

West Palm Beach, FL | United States

Job description

We are seeking an experienced and highly qualified Medical Director to join our team and lead our Utilization Management department. The Medical Director will be responsible for case/utilization management reviews, overseeing the utilization management process, and ensuring the efficient and effective use of healthcare resources while maintaining high standards of care. The successful candidate will play a crucial role in enhancing healthcare services and improving patient outcomes.

Key Responsibilities:

Strategic Leadership:

• Provide strategic direction and leadership for the Utilization Management department.
• Develop and implement utilization management strategies to optimize resource allocation.

Utilization Review:

• Oversee the utilization review process, including denials/appeals, pre-authorization, concurrent review, and retrospective review.
• Ensure compliance with regulatory requirements and industry standards

Quality Improvement:

• Collaborate with quality improvement teams to enhance the quality of healthcare services.
• Identify areas for improvement and implement quality improvement initiatives.

Clinical Oversight:

• Review and approve clinical guidelines and protocols for utilization management.
• Provide clinical expertise and guidance to the utilization management team.

Client Collaboration:

• Collaborate with healthcare entities to foster effective communication and cooperation.
• Address clinical concerns and provide recommendations for improving care delivery.

Data Analysis:

• Analyze utilization data and trends to identify opportunities for cost containment and improved outcomes.
• Develop data-driven recommendations for decision-making.

Team Management:

• Lead and mentor the utilization management team, including nurses and other healthcare professionals.
• Foster a positive and collaborative work environment.

Requirements

Qualifications:

• Medical Doctor (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree.
• Current, unrestricted medical license in the state of practice.
• Ability to obtain a license in MN.
• Board certification in a relevant specialty.
• Highly preferred - Previous experience in utilization management and healthcare administration.
• Strong knowledge of healthcare regulations and accreditation standards.
• Excellent leadership and communication skills.
• Strong analytical and problem-solving abilities.

Job tags

Salary