REMOTE: Medical Director, Utilization Management and Medical Policy

3 weeks ago

Phoenix, United States Evry Health Full time

About the Role

Evry Health is hiring a tech-savvy Medical Director to lead medical policy and utilization management. As a physician, you will work with the actuarial, technology, medical care coordination, and medical quality management teams. You will report directly to the Chief Medical Officer.


About Evry Health and Globe Life

We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives.


Globe Life has recently acquired Evry Health. Globe Life (NYSE:GL) has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.


Key Responsibilities

  • Utilization management.
  • Medical policy.
  • Leading, and working with, the Utilization Management Review Committee.
  • Development of new medical policies.
  • Incorporating regulatory updates, and care guideline updates into medical policy.
  • Medical oversight, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members.
  • Promote positive relations with the local medical community, including periodic consultation with providers, facilities, care givers, etc.
  • Reviews case management data, identifies trends and gaps in care and recommends corrective actions.
  • Provides oversight and direction for staff and provider training and education.
  • Integration of clinical quality and demonstrated best clinical practices into medical management program development. Evaluates the development of new and continuation of existing programs. Investigates future care management and patient engagement technologies and evaluates their impact on providers’ practices, patient safety and patient experience.


Qualifications

  • Active Texas (TX) medical license.
  • A degree as a Medical Doctor is required, with 8+ years of clinical experience in the practice of medicine. Management experience preferred.
  • Board certification in a medical specialty recognized by the American Board of Medical Specialists. Current state license as a MD without restrictions, limitations or sanctions from government programs.
  • Experience working within a health insurance plan, with an emphasis on population health.
  • Experience in managed care and utilization management.
  • Knowledge of managed care systems, quality improvement and clinical acumen.
  • Experience performing utilization management within a health plan.
  • Experience with MCG or other care guidelines.


Telecommuting Requirements

  • Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
  • Ability to keep all company sensitive documents secure.
  • Must live in the United States.
  • Must live in a location that receives an existing high-speed internet connection/service.


Location and Benefits

  • This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
  • Company business hours are weekdays 9-5 CST and weekends 9-noon CST.
  • Full benefits package including health insurance, 401(k) matching, vision, dental, life, disability, and vacation.


Employment Status

Full time - Salary.


Minimum Required Education

A degree as a Medical Doctor is required.


Experience

8+ years of clinical experience in the practice of medicine. Management experience preferred. Experience working within a health insurance plan is required.


To Apply

Please attach your resume when submitting through this LinkedIn posting.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description. Evry Health is an EEO employer (see )

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