Medical Director, Evidence-Based Utilization & Care

Priority Health; Grand Rapids (MI); On-site; USD 180,000 - 280,000; Full time

Job summary

Priority Health is seeking a Medical Director to lead clinical utilization decisions and collaborate with medical communities across Michigan. The role emphasizes evidence-based practice, patient-centered care, and cost-effective management within Priority Health’s mission and strategic goals.

The candidate will engage in peer discussions, participate in denials management, and contribute to population health discussions while maintaining board certification in a medical specialty and Michigan

Qualifications

• Doctorate in a medical field and MD or DO licensure in Michigan.
• Proven experience in clinical settings and managed care.
• Strong communication with physicians and education skills.
• Familiarity with utilization management principles and guidelines.

Responsibilities

• Understand Priority Health’s mission, goals, and value proposition.
• Provide clinical oversight to nurse case management and utilization management.
• Promote patient-centered care and evidence-based medicine.
• Contribute to clinical utilization guidelines and health management programs.
• Collaborate with medical directors and line-of-business leaders.

Skills

Physician communication

Utilization management

Evidence-based medicine

Clinical leadership

Education

Doctorate

Tools

InterQual

Milliman

Job description

Priority Health is seeking a Medical Director to lead clinical utilization decisions and collaborate with medical communities across Michigan. The role emphasizes evidence-based practice, patient-centered care, and cost-effective management within Priority Health’s mission and strategic goals.

The candidate will engage in peer discussions, participate in denials management, and contribute to population health discussions while maintaining board certification in a medical specialty and Michigan