Medical Director, Utilization & Care Management

Intermountain Healthcare Inc.; Georgia; On-site; USD 332,000 - 377,000; Full time

Benefits offered by this job

Leadership incentive opportunity

Sign-on and relocation bonus

Benefits package

Job summary

Intermountain Health in Murray, Utah, seeks a Medical Director for Utilization Management and Care Management to lead UM/CM strategies, ensure high-quality, cost-effective care, and align with accreditation standards.

Reporting to the Chief Medical Officer, this role oversees clinical reviews, prior authorizations, and performance metrics, with opportunities to drive innovation through AI, process improvements, and value-based care initiatives; includes leadership incentives and relocation

Qualifications

• Medical Doctor or Doctor of Osteopathic Medicine with Board Certification in Internal Medicine, Pediatrics, Family Practice, Psychiatry or Emergency Medicine.
• Requires MD or DO licensure in Utah, Idaho, Nevada or Colorado.
• Five years of clinical practice experience.

Responsibilities

• Strategic Leadership: Develop and implement UM and CM strategies using data analytics, technology, and cost-benefit analysis.
• Policy & Process Development: Create and enforce UM/CM policies and procedures to meet regulatory and accreditation requirements.
• Operational Oversight: Manage provider reviewers, concurrent reviews, prior authorizations, medical claims reviews, appeals and grievances; ensure timely and accurate authorizations.
• Efficiency & Innovation: Identify process improvements, redesign workflows, and implement AI solutions to reduce administrative burden.
• Pro-Active Care: Participate in risk-based contracting and reduction of unnecessary authorizations to improve member and provider experience.
• Data & Trend Analysis: Monitor utilization trends, measure productivity, and report cost savings and quality outcomes.
• Provider & Vendor Management: Build relationships with vendors and clinical teams to improve care quality and efficiency.
• Compliance & Quality: Ensure adherence to regulations and quality measures; conduct provider education.
• Team Leadership: Supervise UM/CM staff and support workforce planning.
• Special Projects: Lead initiatives to improve member/provider experience and clinical decision support.

Skills

Leadership

Communication

Taking Initiative

Performance management

Process Improvements

Teamwork

Workflow optimization

Process documentation

Health plan operation

Federal, state and local regulations

Computer Literacy

Education

MD/DO with board certification

Tools

Data analytics

AI solutions

Job description

Intermountain Health in Murray, Utah, seeks a Medical Director for Utilization Management and Care Management to lead UM/CM strategies, ensure high-quality, cost-effective care, and align with accreditation standards.

Reporting to the Chief Medical Officer, this role oversees clinical reviews, prior authorizations, and performance metrics, with opportunities to drive innovation through AI, process improvements, and value-based care initiatives; includes leadership incentives and relocation