Medical Director, Evidence-Based Care & Utilization

Spectrum Health; Grand Rapids (MI); On-site; USD 210,000 - 320,000; Full time

Benefits offered by this job

Comprehensive benefits package

On-demand Pay (Payactiv)

Discounts directory

Identity theft protection

Job summary

Priority Health, a Corewell Health system member, seeks a Medical Director to provide clinical oversight and lead utilization management within our medical affairs team. You will work with lines of business leaders to ensure evidence-based, cost-conscious decisions and guide denials management.

The role requires board certification in a medical or surgical specialty, ongoing maintenance of licensure, and collaboration across networks to improve patient care and outcomes.

Qualifications

• Doctorate in a clinical specialty and 3+ years of clinical experience.
• 3+ years of managed care experience.
• Proven success in physician communication and utilization management strategies.

Responsibilities

• Understand Priority Health’s mission and strategic goals.
• Support medical management and provide clinical oversight to nurse case management.
• Participate in denials management and peer-to-peer clinical discussions.
• Promote evidence-based care standards and development of utilization guidelines.
• Collaborate with medical leadership to ensure compliant, evidence-informed decisions.

Skills

Clinical leadership

Managed care

Physician communication

Education

MD/DO physician

Tools

InterQual

Milliman

Job description

Priority Health, a Corewell Health system member, seeks a Medical Director to provide clinical oversight and lead utilization management within our medical affairs team. You will work with lines of business leaders to ensure evidence-based, cost-conscious decisions and guide denials management.

The role requires board certification in a medical or surgical specialty, ongoing maintenance of licensure, and collaboration across networks to improve patient care and outcomes.