Medical Management Director — Utilization & Policy

ADP, Inc.; Grants Pass (OR); On-site; USD 180,000 - 240,000; Full time

Benefits offered by this job

Affordable healthcare

401k retirement program

Wellness programs

Flexible schedule options

Job summary

AllCare Health in Grants Pass, Oregon, seeks an Associate Medical Director to oversee day-to-day medical management activities, including utilization reviews, appeals, and case consultations. You will work with the Chief Medical Officer to implement strategies, develop policies, and ensure regulatory compliance.

The role expects interaction with providers and leadership to enhance member experience. The position emphasizes leadership in Medical Management, adherence to CMS and NCQA standards,

Qualifications

• Doctoral degree (MD or DO) or advanced practice license incl. NP/PA.
• Current Oregon license or eligible to practice as appropriate.
• Experience in utilization management or case management preferred.

Responsibilities

• Oversee day-to-day medical management activities including utilization reviews.
• Develop and maintain medical policies to support utilization management.
• Collaborate with CMO to address resource utilization and goals.
• Ensure compliance with CMS, NCQA, and regulatory requirements.
• Lead or participate in committees and provide expert guidance.

Skills

Time management

HIPAA knowledge

CMS guidelines

InterQual knowledge

Education

MD/DO or NP/PA

Tools

Microsoft Office

Excel

Word

PowerPoint

Job description

AllCare Health in Grants Pass, Oregon, seeks an Associate Medical Director to oversee day-to-day medical management activities, including utilization reviews, appeals, and case consultations. You will work with the Chief Medical Officer to implement strategies, develop policies, and ensure regulatory compliance.

The role expects interaction with providers and leadership to enhance member experience. The position emphasizes leadership in Medical Management, adherence to CMS and NCQA standards,