Medical Director, Utilization Management — Lead Care

Wellpath; Lemoyne (Cumberland County); On-site; USD 200,000 - 250,000; Full time

Benefits offered by this job

DailyPay

Tuition Assistance

EAP (Counseling & Health Coaching)

Company paid life insurance

Health Spending Accounts (HSA)

Wellness program

Banking partnerships

Job summary

Wellpath is seeking a Medical Director of Utilization Management in Pennsylvania to lead utilization review, case management, quality improvement, and related policy initiatives within their region. This role provides guidance to medical staff, collaborates with external partners, and aims to optimize care delivery and appropriate medical service utilization.

Responsibilities include overseeing concurrent reviews, managing UM staff, driving process improvements, and coordinating with hospital

Qualifications

• MD or DO from an accredited university.
• One (1) year of experience in utilization management is required.
• Current license in state of employment to practice medicine.

Responsibilities

• Ensure the use of nationally recognized criteria and evidence-based standards for inpatient concurrent reviews and offsite service requests.
• Manage UM staff including performance reviews, employee development, hiring, coaching, counseling, and retention.
• Lead UM process improvements, facilitate patient care goals, and utilize data research to reduce length of inpatient stays and decrease ED admissions.
• Evaluate and recommend policy improvement related to utilization review–system, and provide UM updates and participate in meetings.
• Establish and monitor progress towards UM program goals, maintain offsite service and UM tracking/reporting, and facilitate regular meetings with partner hospital clinical regarding offsite services.

Skills

Excellent communication

Organizational skills

Education

MD/DO

Job description

Wellpath is seeking a Medical Director of Utilization Management in Pennsylvania to lead utilization review, case management, quality improvement, and related policy initiatives within their region. This role provides guidance to medical staff, collaborates with external partners, and aims to optimize care delivery and appropriate medical service utilization.

Responsibilities include overseeing concurrent reviews, managing UM staff, driving process improvements, and coordinating with hospital