Medical Director - Utilization Management/Care Management, Select Health

Intermountain Health; San Juan (PR); Presencial; USD 332.000 - 377.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Annual leadership incentive

Sign-on and relocation bonus

Comprehensive benefits

Descripción de la vacante

Select Health in Murray, Utah, seeks an experienced Medical Director with UM/CM expertise to lead and optimize utilization management, care management, and accreditation readiness. You will shape policies, supervise reviewers, and drive innovations to streamline authorizations and improve outcomes.

Strong leadership and regulatory acumen are required. FTE 1.0 with a salary in the range of $332,300–$377,400, plus potential bonus and relocation support.

Formación

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

Responsabilidades

• Provide strategic leadership for UM and CM strategies using data analytics, technology, and cost-benefit analysis.
• Develop and enforce UM/CM policies, procedures, and protocols to meet regulatory standards.
• Oversee provider reviewers, concurrent reviews, prior authorizations, medical claims reviews, appeals and grievances while ensuring timely authorizations.
• Identify process improvements and optimize workflows, including automation and AI-assisted solutions where appropriate.
• Participate in risk-based contracting and other value-based care initiatives to reduce administrative burden.
• Monitor utilization trends, measure productivity, and report cost savings and quality outcomes.
• Build relationships with Select Health vendors and clinical teams to improve care quality and efficiency.
• Ensure compliance with regulations and quality measures; educate providers as needed.
• Lead and mentor UM/CM staff and support workforce planning.
• Lead special projects to improve member and provider experience and reduce unnecessary services.

Conocimientos

Leadership

Communication

Taking Initiative

Performance management

Process Improvements

Teamwork

Workflow optimization

Process documentation

Health plan operation

Federal, state and local regulations

Computer Literacy

Educación

MD/DO with board certification

Descripción del empleo

SelectHealth - Murray

Full time

R174585

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 tooptimizecovered services and care management efforts.

• Policy & Process Development: Participatein the creation, revision and enforcement ofUM/CM policies, procedures, and protocols to meetregulatory and other accreditation requirements.

• Operational Oversight: From a clinical perspective, manage provider reviewers,concurrent reviews, prior authorizations, medical claims reviews, appeals,andgrievancesandensuretimelyandaccurateservice authorizationsconsistent with regulatory and accreditation standards.

• Efficiency & Innovation: Identifyprocess improvements, redesign workflows, and implementprocesses includingauto-approvals, alternative site criteria evaluation,artificial intelligencesolutionsandprior authorizationefficiency whereappropriate toreduce administrative burden.

• Pro- Active Care (Value-based Care): Participatein system innovation opportunities such as risk-based contracting,appropriate reductionof prior authorization or other identified opportunities to affect administrative simplification and reduce abrasion for members and providers.

• Data & Trend Analysis: Monitorutilizationtrends, measure productivity metrics, and report on cost savings and quality outcomesacross areas of responsibility.

• Provider & Vendor Management: Build andmaintainstrong relationships withsuch 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 trainingas necessary tofacilitatecomplianceand adherence to quality measures.

• Team Leadership: Supervise and mentor UM/CM staff,provideexecutive-level guidance, and support workforce planningas 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

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$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 (https://intermountainhealthcare.org/careers/benefits) .

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.

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All positions subject to close without notice.

Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400+ clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.

Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment.

Intermountain Health strives to make the application process accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact 1-800-843-7820 or email [e-mail] . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more. (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/peak-program/)

The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor.

All positions subject to close without notice.

Thanks for your interest in continuing your career with our team!