Medical Director

Medical Director page is loaded## Medical Directorremote type: Remote - Full Timelocations: US-California-Remote: Connecticut, USA: California, USA: District of Columbia, USA: Montana, USAtime type: Full timeposted on: Posted Todayjob requisition id: M101457**Job Description Summary**The Utilization Management (UM) Medical Director provides clinical leadership for the UM program, ensuring members receive appropriate, high-quality care. You will oversee review guidelines, collaborate with internal teams and external partners, and drive compliance with regulatory and accreditation standards.**How will you make an impact & Requirements**W*ith nearly 30 years of experience in providing advanced primary care, CareMore APC delivers exceptional patient experiences. Compassionate clinicians take the time to understand each patient’s unique health needs while also removing barriers to access. Patients trust us to receive the right personalized care where and when they need it – in our care centers, at home or virtually – to improve their health outcomes and quality of life.***Key Responsibilities*** Lead the development, implementation, and periodic review of UM policies and clinical criteria* Provide physician oversight for concurrent and retrospective review activities* Approve and interpret clinical guidelines, pathways, and criteria for admission, continued stay, and discharge* Serve as the primary clinical liaison with payers, providers, and regulatory bodies* Mentor and educate UM nurses, physician reviewers, and other staff on best practices* Analyze utilization data and quality metrics to identify trends and areas for improvement* Participate in appeals and peer-to-peer discussions to resolve clinical disputes* Maintain compliance with NCQA, URAC, CMS, state regulations, and organizational standards**Qualifications*** Medical degree (MD or DO) from an accredited institution* Active, unrestricted medical license in [State/Region]* Board certification in an acute-care specialty (e.g., Internal Medicine, Family Medicine, Pediatrics)* Minimum of 5 years clinical practice experience, with 2+ years in utilization management or managed careCompensation: $263,488K - $329,360K & bonus eligibleAt Carelon Health, we provide effective Advanced Primary Care and Palliative Care by seeing the whole person — body, mind, and spirit. We do it with doctors and nurses who provide personalized and compassionate care, nationally recognized disease prevention and management programs, and healthy-living plans. It helps patients get healthier, while receiving the healthcare experience they’ve always wanted.Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. The Business Units which comprise Mosaic Health are multi-payer and serve nearly one million consumers across 19 states, providing them with access to high quality primary care, integrated care teams, personalized navigation, expanded digital access, and specialized services for higher-need populations. Through Mosaic Health, health plans and employers have an even stronger care provider partner that delivers affordability and superior experiences for their members and employees, including value-based primary care capacity integrated with digital patient engagement and navigation. Each of the companies within Mosaic Health provide unique offerings that together promise to improve individuals' health and wellbeing, while helping care providers deliver higher quality care. For more information, please visit or follow .Mosaic Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. If you require an accommodation for the application or interview process, please let us know and we will work with you to meet your needs. Please contact recruiting@apree.health for assistance.
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