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Medical Director - Utilization Management

Company: P3 Health Partners
Location: Henderson
Posted on: January 13, 2022

Job Description:

P3 Health Partners is committed to ensuring the health and safety of our team members, patients and communities we serve. As a part of this commitment, all candidates must receive their COVID-19 vaccine prior to joining the team. If you have any questions about our interview and hiring procedures, please contact PeopleServices@p3hp.org.

People. Passion. Purpose.
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.

We are looking for a Medical Director - Utilization Management If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Roseburg, Oregon then you should consider joining our team.

Medical Director - Utilization Management

Job Description:
Provide clinical expertise across the enterprise for various functions.
Responsible for corporate and medical policy interpretation, recommendation, and review within recognized areas of responsibility.
Advise and collaborate in the develop of clinical programs.
Provide clinical support and participate in utilization management programs and identify opportunities for improvement and efficiency.
Provide clinical leadership for medical necessity reviews and application of clinical guidelines in decision making.
Assist is establishing corporate and regional programs to enhance quality of care reduce medical costs and achieve positive health outcomes.
Serves as a clinical resource and subject matter expert to both clinical and non - clinical staff.
Perform clinical reviews and conduct peer to peers.
Conduct discussions with physicians in the P3 Health Partners network regarding medical policies, utilization management, claims editing, use of resources and quality.
Perform high dollar claims and complex case reviews.
Participate in inter-rater reliability activities.
Participate in committees and workgroups to achieve department and corporate objectives
Participate in health plan Joint Operating Committees.

Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required.
Seven (7) years of clinical practice experience.
Two (2) years of previous medical director experience working for a health plan, medical group, or hospital in a utilization management or medical management preferred.
Current unrestricted state of Nevada Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) license.
Board certified or board eligible and working towards certification in a specialty approved by the American Board of Medical Specialists or the American Board of Osteopathy
Certification in Utilization Review and Health Care Quality & Management is preferred.
Ability to effectively communication with external physicians and organizations
Proven leadership, problem solving and the ability to manage multiple priorities.
Results oriented and the ability to take ownership for initiatives and collaborate with cross-functional teams to achieve department and corporate goals.
Demonstrate skill with Microsoft Office Suite and web-based program.
Understanding of health plan and medical group functions related to utilization, care, as well as HEDIS/STAR s and NCQA. Familiarity with CMS regulations and standards.
Basic knowledge of evidence-based clinical decision support guidelines (Inter Qual/Milliman).
Basic knowledge of CPT coding and guidelines.
Other related skills and/or abilities may be required to perform this job.

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

At P3, we recognize and appreciate the importance of creating an environment in which all team members feel valued, included, and empowered to do their best work and bring great ideas to the table
Every P3 family member's unique experiences, perspectives, and viewpoints are valued and support our ability to deliver the best possible experience for our patients, providers, payers, partners, and each other.

Keywords: P3 Health Partners, Henderson , Medical Director - Utilization Management, Healthcare , Henderson, Nevada

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