Ohio Licensed Utilization Management Physician Reviewer

Clearlink Partners; United States; Presencial; USD 138.000 - 207.000; Jornada completa

Descripción de la vacante

Clearlink Partners, a leading managed care consultancy, seeks an executive to spearhead medical management strategy for health plans across Medicare, Medicaid, and commercial lines. You will guide utilization strategies, policy development, and regulatory compliance, collaborating with client executives to align objectives with outcomes.

The role requires 10+ years in health plan operations, MD/DO license, and CMO-level experience; travel may be involved and strong cross-functional leadership is

Formación

• MD or DO and active medical license; healthcare leadership required.
• 10+ years in health plan operations with progressive responsibility.
• CMO level experience preferred.
• Experience in Medicare/Medicaid and commercial lines.
• Ability to translate trends into scalable activities and outcomes.
• Knowledge of legal/regulatory healthcare frameworks (HIPAA, Knox-Keene).

Responsabilidades

• Provide strategic direction for health plan market/product medical management and oversight.
• Lead engagements and ensure completion of contracted services.
• Present findings and plans to client executives.
• Mentor staff and guide clinical criteria and utilization trends.
• Ensure compliance with federal/state regulations and NCQA/URAC standards.
• Drive quality improvement and population health initiatives.

Conocimientos

C-Suite experience

Strategy development

Leadership

Project management

Communication

Educación

MD or DO

Master's in Healthcare or MBA

Herramientas

Excel

PowerPoint

Word

Visio

Descripción del empleo

Clearlink Partners, a leading managed care consultancy, seeks an executive to spearhead medical management strategy for health plans across Medicare, Medicaid, and commercial lines. You will guide utilization strategies, policy development, and regulatory compliance, collaborating with client executives to align objectives with outcomes.

The role requires 10+ years in health plan operations, MD/DO license, and CMO-level experience; travel may be involved and strong cross-functional leadership is