Manager, Utilization Management Medical Director

Medical Mutual•Cleveland, OH

1d•Hybrid

About The Position

Provides leadership to Assistant Medical Director teams based upon specialty or geographic area and performs utilization management review in area of expertise. Fosters continuous improvement in policies, processes, and all parts of the operations. Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Requirements

MD or DO from an accredited medical school with an active, unrestricted (state) license to practice medicine in United States
Minimum of 5 years of established (clinical) care practice experience required
Board Certification, in nationally recognized specialty (ABMS or AOA) is required.
Active Unrestricted license to practice medicine in US
Foundational windows-based computer skills, including typing, word processing, presentation, and internet research skills.
Strong understanding of integration of evidence-based medicine and managed care principles.

Nice To Haves

Physician reviewer experience in the insurance industry preferred

Responsibilities

Oversee physician’s utilization review process and determinations.
Participate in quality processes such as audits and quality improvement projects.
Provide leadership support to assistant medical directors
Ensure physician compliance with clinical goals through monitoring of care management performance.
Recommend changes and enhancements to current managed care, review guidelines, and clinical criteria based on clinical knowledge of health care delivery systems, utilization methods, reimbursement methods and treatment protocols.
Provide guidance to assistant medical director team in the coordination of quality care.
Performs other duties as assigned.

Benefits

Laptop, monitors, keyboard, mouse and headset provided
On-site fitness centers or gym membership reimbursement
On-site cafeteria
Discounts at many places
Cash rewards for shopping with customers
Business casual attire
Employee bonus program
401(k) with company match up to 4% and an additional company contribution
Health Savings Account with a company matching contribution
Medical, dental, vision, life and disability insurance
Employee Assistance Program
Company holidays
Up to 16 PTO days during the first year of employment with options to carry over unused PTO time
Parental leave for eligible employees who become parents through maternity, paternity or adoption
Career development programs and classes
Mentoring and coaching
Tuition reimbursement up to $5,250 per year
Diverse, inclusive and welcoming culture with Business Resource Groups