Senior Medical Director, Utilization & Care Management

Physician Pivot; Murray (UT); On-site; USD 332,000 - 377,000; Full time

Benefits offered by this job

Sign-on bonus

Relocation bonus

Job summary

Select Health in Murray, Utah seeks an experienced Medical Director of Utilization Management and Care Management to lead clinical UM/CM functions, ensuring high-quality, efficient, and compliant care. You will drive policies, workforce leadership, and collaboration with vendors and providers to achieve outcomes.

The role emphasizes data-driven oversight, performance metrics, and strategic initiatives to reduce unnecessary services while improving patient care and regulatory alignment.

Qualifications

• MD/DO degree with Board Certification in Internal Medicine, Pediatrics, Family Practice, Psychiatry or Emergency Medicine.
• Requires current MD or DO licensure within the states Utah, Idaho, Nevada or Colorado.

Responsibilities

• Lead UM and CM strategies and operations from a clinical perspective.
• Develop and enforce UM/CM policies, procedures and protocols to meet regulatory and accreditation requirements.
• Oversee provider reviewers, concurrent reviews, prior authorizations, medical claims reviews, appeals and grievances.
• Identify process improvements and implement optimized workflows and automation to reduce administrative burden.
• Participate in risk-based contracting and other value-based care initiatives to improve efficiency and reduce abrasion for members and providers.
• Monitor utilization trends, productivity metrics, and report on cost savings and quality outcomes.
• Build and maintain relationships with vendors and clinical teams to improve care quality and efficiency.
• Ensure compliance with state/federal regulations and accreditation standards; educate providers as needed.
• Provide executive leadership to UM/CM staff and support workforce planning.
• Lead special projects to improve member/provider experience and support clinical decision making.

Skills

Leadership

Communication

Taking Initiative

Performance management

Process Improvements

Teamwork

Workflow optimization

Process documentation

Health plan operation

Regulatory knowledge

Education

MD/DO with board certification

Job description

Select Health in Murray, Utah seeks an experienced Medical Director of Utilization Management and Care Management to lead clinical UM/CM functions, ensuring high-quality, efficient, and compliant care. You will drive policies, workforce leadership, and collaboration with vendors and providers to achieve outcomes.

The role emphasizes data-driven oversight, performance metrics, and strategic initiatives to reduce unnecessary services while improving patient care and regulatory alignment.