Part-Time Medical Director, Utilization Management

Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree. Preferably Board Certified Family Practitioner or Internal Medical Specialist. Unrestricted licensed in at least one state within the United States. 5+ years of clinical practice experience. 2+ years of experience in utilization management activities. Proficiency with Microsoft Office applications. M.D or D.O and five (5) years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. Board Certified in an American Board of Medical Specialties Board. Active, unrestricted license to practice medicine in a state or territory of the United States. Previous experience with administrative oversight of the medical function of an insurance (or related) company. Previous experience leading a team of professionals. Strong perspective on increasing operational excellence and automation. Strong interpersonal skills. Ability to balance critical thinking with hands-on execution. Results-driven. Ability to work in a fast-paced and changing environment. Self-starter with strong organizational skills. Excellent oral and written communication skills.

Assist in developing and maintaining an efficient UM program. Educate physicians on regulatory compliance. Develop strategies for improving market performance. Participate in case reviews and medical necessity determination. Serve as a resource for clinical staff. Conduct post-service reviews. Maintain accurate documentation. Analyze aggregate data and report to physicians. Serve as liaison between physicians and health plan Medical Directors. Perform secondary reviews. Participate in Grievance and Appeal review process. Utilize clinical expertise to identify salient points in case reviews. Identify process improvement opportunities and inefficiencies. Interact with external physicians. Collaborate with management on solutions for improving quality.