Medical Director - Utilization Management/Care Management, Select Health

Intermountain Healthcare Inc.; Murray (UT); On-site; USD 332,000 - 377,000; Full time

Benefits offered by this job

annual leadership incentive program

sign-on and relocation bonus

generous benefits package

Job summary

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

Qualifications

• 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.

Responsibilities

• 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.

Skills

Leadership

Communication

Taking Initiative

Performance management

Process Improvements

Teamwork

Workflow optimization

Process documentation

Health plan operation

Regulatory knowledge

Computer Literacy

Education

MD/DO with board certification

Job description

Job Description

Select Health, a regional health plan with over a million members serving all lines of business in Utah, Idaho, Nevada and Colorado, is seeking an experienced Medical Director with expertise in Utilization Management (UM), Care Management (CM) and Health Plan accreditation and other operational and regulatory functions.

Essential Functions

Key Responsibilities

• Strategic Leadership: Develop and implement UM and CM strategies using data analytics, technology, and cost-benefit analysis to optimize covered services and care management efforts.
• Policy & Process Development: Participate in the creation, revision and enforcement of UM/CM policies, procedures, and protocols to meet regulatory and other accreditation requirements .
• Operational Oversight: From a clinical perspective, manage provider reviewers, concurrent reviews, prior authorizations, medical claims reviews, appeals, and grievances and ensure timely and accurate service authorizations consistent with regulatory and accreditation standards .
• Efficiency & Innovation: Identify process improvements, redesign workflows, and implement processes including auto-approvals , alternative site criteria evaluation , artificial intelligence solutions and prior auth orization efficiency where appropriate to reduce administrative burden.
• Pro- Active Care (Value-based Care): Participate in system innovation opportunities such as risk-based contracting, appropriate reduction of prior authorization or other identified opportunities to affect administrative simplification and reduce abrasion for members and providers.
• Data & Trend Analysis: Monitor utilization trends, measure productivity metrics, and report on cost savings and quality outcomes across areas of responsibility .
• Provider & Vendor Management: Build and maintain strong relationships with such Select Health required vendors and clinical teams necessary to improve care quality and efficiency.
• Compliance & Quality: Ensure adherence to state/federal regulations, accreditation standards, and contractual obligations; conduct provider education and training as necessary to facilitate compliance and adherence to quality measures .
• Team Leadership: Supervise and mentor UM/CM staff, provide executive-level guidance, and support workforce planning as needed .
• Special Projects: Lead initiatives to improve member/provider experience, reduce unnecessary services, and enhance 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

Additional Details

• FTE: 1.0
• Salary: $332,300 - 377,400 based on relevant experience
• Eligible for an annual leadership incentive opportunity based on system goals
• In addition to the annual salary, to show our commitment to you and assist with your transition, we may offer a sign-on and relocation bonus when applicable.

Minimum Qualifications

• Medical Doctor or Doctor of Osteopathic Medicine degree with Board Certification in one of the following areas: Internal Medicine, Pediatrics, Family Practice, Psychiatry or Emergency Medicine.
• Requires current MD or DO licensure within the State of Utah, Idaho, Nevada or Colorado
• Five years of experience in clinical practice.

Preferred Qualifications

• Utilization management, care management and/or experience in policy related work for a health plan or managed care organization.
• Previous management experience.
• Experience with financial and medical expense management.
• Understanding of health care delivery system as it relates to government programs and agencies.
• Excellent communication skills including ability to establish and maintain rapport with coworkers, providers, brokers, employers, plan members, representatives/executives from other health care entities, government and regulatory bodies and others in the community.

Physical Requirements

• Ongoing need for employees to see and read information, documents, monitors, identify equipment and supplies, and be able to assess member, provider, and coworkers' needs.
• Frequent interactions with colleagues and providers require employees to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Frequent computer use for typing, accessing needed information, etc.

Location

SelectHealth - Murray

Work City

Murray

Work State

Utah

Scheduled Weekly Hours

36

Hourly Range

$70.00 - $999.99

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here .

By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we usethe artificial intelligence ("AI") platform, HiredScore to improve your job application experience.HiredScore helps match your skills and experiences to the best jobs for you. WhileHiredScore assists in reviewing applications, all final decisions are made byIntermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.