Director Utilization Mgmt

Wellpath / Correct Care Solutions; Freehold (NJ); On-site; USD 199,992 - 249,995; Full time

Benefits offered by this job

DailyPay, receive your money as you earn it

Tuition Assistance

Employee Assistance Program (EAP)

Company paid life insurance

Health Spending Accounts (HSA)

Wellness program

Preferred banking partnership and discounted rates for loans

Job summary

A healthcare organization in Freehold, New Jersey is seeking a Medical Director for Utilization Management. The role involves leading utilization reviews, guiding medical staff, and optimizing care delivery. Candidates must have an M.D. or D.O. degree, and one year of utilization management experience is required. Strong communication and organizational skills are essential. This position is based in Lemoyne, Pennsylvania at the Regional Office and includes a competitive salary with extensive benefits including wellness programs and tuition assistance.

Qualifications

• One year of experience in utilization management is required.
• Excellent communication and organizational skills required.
• Experience in performance and/or quality improvement preferred.

Responsibilities

• Lead and oversee utilization review, case management, and quality improvement.
• Provide guidance to medical staff for quality patient care.
• Evaluate and recommend policy improvements related to utilization review.

Skills

Communication skills

Organizational skills

Education

Medical Doctor (M.D.) or Osteopathic Doctor (D.O.) from an accredited university

Job description

We're on a path to better healthcare.
Join us

Compensation Information: $199,992 - $249,995.2 / year

Department (Org): Regional Office

You Matter

• Make a difference every day in the lives of the underserved
• Join a mission driven organization with a people first culture
• Excellent career growth opportunities

Join us and find a career that supports:

• Caring for overlooked, underserved, and vulnerable patients
• Diversity, equity, inclusion, and belonging
• Autonomy in a warm team environment
• Growth and training

Perks and Benefits

In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including:

• DailyPay, receive your money as you earn it!
• Tuition Assistance and dependent Scholarships
• Employee Assistance Program (EAP) including free counseling and health coaching
• Company paid life insurance
• Tax free Health Spending Accounts (HSA)
• Wellness program featuring fitness memberships and product discounts
• Preferred banking partnership and discounted rates for home and auto loans

*Eligibility for perks and benefits varies based on employee type and length of service.

Why Us

Now is your moment to make a difference in the lives of the underserved.

If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time.

Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan.

We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support.

How you make a difference

The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within their assigned area. They provide guidance and direction to medical staff in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders, and works collaboratively with internal teams to optimize care delivery and achieve operational goals.

Key Responsibilities

• Ensure the use of nationally recognized criteria and evidence-based standards for inpatient concurrent reviews and offsite service requests.
• Manage UM staff including performance reviews, employee development, hiring, coaching, counseling, and retention.
• Lead UM process improvements, facilitate patient care goals, and utilize data research to reduce length of inpatient stays and decrease ED admissions.
• Evaluate and recommend policy improvement related to utilization review system, and provide UM updates and participate in meetings.
• Establish and monitor progress towards UM program goals, maintain offsite service and UM tracking/reporting, and facilitate regular meetings with partner hospital clinical regarding offsite services.

Qualifications & Requirements

Education

• Medical Doctor (M.D.) or Osteopathic Doctor (D.O.) from an accredited university

Experience

• One (1) year of experience in utilization management is required.
• Excellent communication and organizational skills required.
• Experience in Performance and/or Quality Improvement preferred.

Licenses/Certifications

• Current license in state of employment to practice medicine

This is an onsite role based in Lemoyne, Pennsylvania at our Regional Office.

We are an Equal Employment Opportunity/Affirmative Action Employer

We celebrate diversity and are committed to creating an inclusive environment for all employees.

We encourage you to apply!

If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles.