Manager, Utilization Management Medical Director

Medical Mutual; Brooklyn (OH); Hybrid; USD 250,000 - 300,000; Full time

Benefits offered by this job

Flexible remote work

Company match 401(k)

Tuition reimbursement up to $5,250

Access to fitness centers

Job summary

Medical Mutual is seeking a physician for a leadership role in utilization management based in Brooklyn, Ohio. The position involves overseeing physician review processes and ensuring compliance with clinical goals while fostering continuous improvement.

The ideal candidate will have an MD or DO, at least 5 years of clinical practice experience, and a background in the insurance industry. This hybrid role requires presence at the office on designated days.

Qualifications

• Must have an active, unrestricted license to practice medicine in the USA.
• Minimum of 5 years of clinical practice experience required.
• Experience as a physician reviewer preferred.

Responsibilities

• Oversee utilization review process and determinations.
• Participate in quality improvement projects.
• Ensure physician compliance with clinical goals.
• Recommend enhancements to managed care guidelines.

Skills

Leadership skills

Utilization management review

Clinical care practice experience

Understanding of managed care principles

Computer proficiency

Education

MD or DO from an accredited medical school

Board Certification in recognized specialty

Tools

Microsoft Office

Job description

Medical Mutual employees must submit their applications through MySource.

Job Summary

Provides leadership to AMD teams based upon specialty or geographic area and performs utilization management review in area of expertise. Fosters continuous improvement in policies, processes, and all parts of the operations.

Responsibilities

• Oversee physician's utilization review process and determinations.
• Participate in quality processes such as audits and quality improvement projects.
• Provide leadership support to assistant medical directors
• Ensure physician compliance with clinical goals through monitoring of care management performance.
• Recommend changes and enhancements to current managed care, review guidelines, and clinical criteria based on clinical knowledge of health care delivery systems, utilization methods, reimbursement methods and treatment protocols.
• Provide guidance to assistant medical director team in the coordination of quality care.
• Performs other duties as assigned.

Qualifications

Education and Experience

• MD or DO from an accredited medical school with an active, unrestricted (state) license to practice medicine in United States
• Minimum of 5 years of established (clinical) care practice experience required
• Physician reviewer experience in the insurance industry preferred

Professional Certification(s)

• Board Certification, in nationally recognized specialty (ABMS or AOA) is required.
• Active Unrestricted license to practice medicine in US

Technical Skills and Knowledge

• Foundational windows-based computer skills, including typing, word processing, presentation, and internet research skills.
• Strong understanding of integration of evidence-based medicine and managed care principles.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

A hybrid‑remote role based out of the Brooklyn, OH office, with employees expected to work onsite on designated in‑office days each week.

A Great Place to Work

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on‑site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On‑site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self‑help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self‑funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio; we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug‑free workplace and perform pre‑employment substance abuse and nicotine testing.