Medical Director II, Utilization Management

Devoted Health; United States; On-site; USD 280,000 - 345,000; Full time

Benefits offered by this job

Employer-sponsored health plan

Generous paid time off

Monthly mobile or internet stipend

Stock options

401(k) program

Job summary

Devoted Health is looking for a Medical Director in Utilization Management to oversee and enhance the utilization management program. This role requires extensive clinical experience and a strong background in medical services management.

The Medical Director will lead clinical reviews, mentor clinical teams, and ensure the efficient use of medical services in line with established guidelines.

Compensation ranges from $280,000 to $345,000 per year, along with an employer-sponsored health plan and generous paid time off.

Qualifications

• Five or more years of clinical practice experience required.
• Three years of previous medical director experience in utilization management or medical management.

Responsibilities

• Assist in the development of an efficient UM program for health plan members.
• Perform clinical reviews and conduct peer-to-peer discussions.
• Provide mentoring and leadership to clinical teams.

Skills

Clinical practice experience

Leadership

Utilization management expertise

Data analytics

Education

Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.)

Job description

Job Description

We are seeking a Medical Director in Utilization Management to interact with utilization management, clinical management, pharmacy, network management, data analytics, legal, and finance departments, and provide leadership in the appropriate use of medical services within established quality and evidence‑based guidelines.

Responsibilities and Impact

• Assist in development and maintenance of an efficient UM program to meet the needs of health plan members commensurate with company values.
• Perform clinical reviews (i.e., Part A, B, appeals, quality of care) and conduct peer‑to‑peer discussions.
• Participate in inter‑rater reliability activities.
• Participate in analysis of utilization data and suggest improvement opportunities.
• Provide mentoring and leadership to clinical teams and develop relationships to support growth and fiscal responsibility.
• Participate in committees and workgroups to achieve department and corporate objectives.
• Provide clinical support and participate in utilization management, quality management, clinical services and care management programs to identify opportunities for improvement and efficiency.
• Serve as a clinical resource and subject matter expert to both clinical and non‑clinical staff throughout the Devoted Health Plan.
• Actively participate in acute and post‑acute clinical rounds.
• Conduct discussions with physicians in the Devoted network regarding medical policies, utilization management, use of resources, and quality.

Required Skills and Experience

• Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required.
• Five or more years of clinical practice experience.
• Three (3) years of previous medical director experience working for a health plan, medical group, or hospital in utilization management or medical management.

Desired Skills and Experience

• Passionate about work, eager to have fun with the team, and motivated to be part of a fast‑growing organization.
• Excited by the process of developing and implementing new processes.
• Believes that population health and a focus on smart allocation of scarce resources can lead to high‑value care both in terms of quality and safety.
• Ability to remain calm in the midst of the storm, guiding others to smart, effective solutions.
• Comfort with ambiguity and a love for problem solving.

Salary Range

280,000 - 345,000 / year

Total Rewards

• Employer‑sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• 100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; commission eligibility for sales roles
• Parental leave program
• 401(k) program
• And more.

Our total rewards package is for full‑time employees only. Intern and contract positions are not eligible.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values, and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.