Medical Director, Utilization & Care Management

Intermountain Healthcare Inc.; Murray (UT); Vor Ort; USD 332.000 - 377.000; Vollzeit

Benefits dieser Stelle

annual leadership incentive program

sign-on and relocation bonus

generous benefits package

Zusammenfassung

Intermountain Health is seeking an experienced Medical Director with expertise in Utilization Management and Care Management to lead policy development, provider oversight, and value-based care initiatives in Utah. The role emphasizes regulatory compliance and performance improvement to enhance care quality and reduce administrative burden.

The ideal candidate will supervise UM/CM staff, collaborate with clinical and vendor teams, and ensure alignment with accreditation standards while guiding

Qualifikationen

• MD/DO degree with Board Certification in a primary care or hospital-based field.
• Current MD or DO licensure in Utah, Idaho, Nevada or Colorado.
• Minimum of five years of clinical practice.

Aufgaben

• Develop and implement UM and CM strategies using data analytics and cost-benefit analysis.
• Develop and enforce UM/CM policies, procedures, and protocols to meet regulatory and accreditation requirements.
• Oversee clinical activities: concurrent reviews, prior authorizations, medical claims reviews, appeals and grievances.
• Identify process improvements and reduce administrative burden through workflow redesign and automation.
• Participate in risk-based contracting and initiatives to simplify administration for members and providers.
• Monitor utilization trends and report cost savings and quality outcomes.
• Manage relationships with required vendors and clinical teams to improve care quality.
• Ensure compliance with state/federal regulations and accreditation standards; educate providers accordingly.
• Supervise and mentor UM/CM staff and support workforce planning.
• Lead projects to improve member/provider experience and clinical decision support.

Kenntnisse

Leadership

Communication

Taking Initiative

Performance management

Process Improvements

Teamwork

Workflow optimization

Process documentation

Health plan operation

Regulatory knowledge

Computer Literacy

Ausbildung

MD/DO with board certification

Jobbeschreibung

Intermountain Health is seeking an experienced Medical Director with expertise in Utilization Management and Care Management to lead policy development, provider oversight, and value-based care initiatives in Utah. The role emphasizes regulatory compliance and performance improvement to enhance care quality and reduce administrative burden.

The ideal candidate will supervise UM/CM staff, collaborate with clinical and vendor teams, and ensure alignment with accreditation standards while guiding