Medical Director - Utilization Management/Care Management, Select Health

Intermountain Health • SelectHealth - Murray, GA

3d • $332,300 - $377,400 • Onsite

About The Position

Select Health, a regional health plan with over a million members across Utah, Idaho, Nevada, and Colorado, is seeking an experienced Medical Director with expertise in utilization management (UM), care management (CM), health plan accreditation, and operational and regulatory functions. Reporting directly to the Chief Medical Officer, the Medical Director leads UM and CM functions from a clinical perspective, ensuring care services are high quality, appropriate, efficient, cost-effective, and compliant with regulatory and accreditation standards. The role combines oversight of UM and CM with Select Health strategies to support members’ access to appropriate care and services.

The position develops and implements UM and CM strategies using data analytics, technology, and cost-benefit analysis; participates in developing and enforcing policies and procedures; and provides clinical oversight of provider reviewers, concurrent reviews, prior authorizations, medical claims reviews, appeals, and grievances. It also identifies process improvements and workflow redesign opportunities, including auto-approvals, alternative-site criteria, artificial intelligence solutions, and prior authorization efficiencies. The Medical Director contributes to value-based care and system innovation, monitors utilization and performance trends, manages vendor and provider relationships, oversees compliance and quality activities, supervises and mentors staff, and leads special projects to improve member and provider experience.

The role is based at SelectHealth in Murray, Utah. It is listed as 1.0 FTE with 36 scheduled weekly hours. The stated salary range is $332,300–$377,400, based on relevant experience; an annual leadership incentive opportunity is available based on system goals. A sign-on and relocation bonus may be offered when applicable. The posting also lists an hourly range of $70.00–$999.99, with the actual hourly rate dependent on experience.

Requirements

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree.
• Board certification in Internal Medicine, Pediatrics, Family Practice, Psychiatry, or Emergency Medicine.
• Current MD or DO licensure in Utah, Idaho, Nevada, or Colorado.
• Five years of clinical practice experience.
• Skills in leadership, communication, taking initiative, performance management, process improvement, teamwork, workflow optimization, process documentation, health plan operations, federal/state/local regulations, and computer literacy.

Nice To Haves

• Utilization management, care management, and/or policy-related work experience for a health plan or managed care organization.
• Previous management experience.
• Experience with financial and medical expense management.
• Understanding of the health care delivery system as it relates to government programs and agencies.
• Excellent communication skills and ability to establish and maintain rapport with coworkers, providers, brokers, employers, plan members, representatives and executives from other health care entities, government and regulatory bodies, and others in the community.

Responsibilities

• Develop and implement UM and CM strategies using data analytics, technology, and cost-benefit analysis.
• Participate in creating, revising, and enforcing UM/CM policies, procedures, and protocols to meet regulatory and accreditation requirements.
• Provide clinical oversight of provider reviewers, concurrent reviews, prior authorizations, medical claims reviews, appeals, and grievances, ensuring timely and accurate service authorizations.
• Identify process improvements, redesign workflows, and implement appropriate solutions such as auto-approvals, alternative-site criteria evaluation, artificial intelligence, and prior authorization efficiencies.
• Participate in system innovation opportunities, including risk-based contracting and appropriate reductions in prior authorization, to simplify administration and reduce member and provider abrasion.
• Monitor utilization trends and productivity metrics, and report on cost savings and quality outcomes.
• Build and maintain relationships with required Select Health vendors and clinical teams to improve care quality and efficiency.
• Ensure adherence to state and federal regulations, accreditation standards, and contractual obligations.
• Conduct provider education and training as needed to support compliance and quality measures.
• Supervise and mentor UM/CM staff, provide executive-level guidance, and support workforce planning as needed.
• Lead special projects to improve member and provider experience, reduce unnecessary services, and enhance clinical decision support.

Benefits

• Annual leadership incentive opportunity based on system goals.
• Sign-on and relocation bonus may be offered when applicable.
• Comprehensive benefits package covering programs intended to support well-being and wellness.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: Ph.D. or professional degree