Director Utilization Mgmt (DO OR MD REQUIRED)

Wellpath; Lemoyne (Cumberland County); On-site; USD 200,000 - 250,000; Full time

Benefits offered by this job

DailyPay

Tuition Assistance

EAP (Counseling & Health Coaching)

Company paid life insurance

Health Spending Accounts (HSA)

Wellness program

Banking partnerships

Job summary

Wellpath is seeking a Medical Director of Utilization Management in Pennsylvania to lead utilization review, case management, quality improvement, and related policy initiatives within their region. This role provides guidance to medical staff, collaborates with external partners, and aims to optimize care delivery and appropriate medical service utilization.

Responsibilities include overseeing concurrent reviews, managing UM staff, driving process improvements, and coordinating with hospital

Qualifications

• MD or DO from an accredited university.
• One (1) year of experience in utilization management is required.
• Current license in state of employment to practice medicine.

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.

Skills

Excellent communication

Organizational skills

Education

MD/DO

Job description

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

• 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

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 reviewsystem, andprovide 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

We are an Equal Employment Opportunity Employer

We value the contributions of team members with a broad range of experiences, skills, and perspectives and are committed to providing equal employment opportunity for all.

This position is available only to those who reside in the United States.

Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description.

Job 25-180269

Facility PA DOC Regional Office

Type Full-Time

Shift Day 8 hour

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