Medical Director, Utilization & Care Management

AdventHealth; Florida; On-site; USD 250,000 - 375,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Life Insurance

Disability Insurance

403-B Retirement Plan

Paid Parental Leave (4 weeks)

Career Development

Whole Person Well-being Resources

Mental Health Resources

Pet Benefits

Job summary

AdventHealth in Florida seeks a physician leader to support Utilization Management and Care Management. You will educate medical staff, guide clinical reviews, and coordinate with payors and ACO programs to promote high-quality, cost-efficient patient care.

The role emphasizes building relationships with physicians, leading UM/CM processes, and improving documentation and outcomes in a complex healthcare setting.

Qualifications

• Doctorate degree must be in medicine and licensed to practice.
• Master's degree is preferred for advanced management duties.

Responsibilities

• Provides clinical support and validation for Utilization Management (UM) and Care Management (CM).
• Educates and serves as a resource to Medical Staff on UM/CM best practices and clinical guidelines.
• Builds effective relationships with physicians and UM/CM stakeholders.
• Advises UM/CM on approaches to clinical questions and provider interactions.
• Serves as liaison between facilities, payors, physicians, and ACO programs.
• Guides UM staff on authorizations, concurrent review, denials, and medical necessity criteria.
• Performs secondary inpatient review escalations and evaluates utilization patterns.
• Supports formulation of clinical arguments for level-of-care determinations.

Skills

Organizational skills

Analytical thinking

Problem solving

Oral and written communication

Microsoft Office

Matrix management

Policy & ethics translation

Medical advice

Physician collaboration

Payor operations

Physician group model experience

Relationship building in medical/corp.

Education

Doctorate

Master's (Preferred)

Tools

Microsoft Office

Job description

AdventHealth in Florida seeks a physician leader to support Utilization Management and Care Management. You will educate medical staff, guide clinical reviews, and coordinate with payors and ACO programs to promote high-quality, cost-efficient patient care.

The role emphasizes building relationships with physicians, leading UM/CM processes, and improving documentation and outcomes in a complex healthcare setting.