Physician Supervisor, Utilization Management

CVS Health • Chicago, IL

1d • Hybrid

About The Position

The Physician Supervisor, Utilization Management is responsible for overseeing the day to day utilization management (UM) processes to ensure the delivery of high-quality, cost-effective healthcare services. This role involves managing the review of medical necessity, appropriateness of care, and the coordination of healthcare services. The Physician Supervisor will lead and manage a team of UM physicians, providing guidance, support, and professional development opportunities to optimize team performance.

Requirements

• At least 2 years experience providing Utilization Management services to a Medicare and/or Medicaid line of business
• Excellent verbal and written communication skills
• A current, clinical, unrestricted license to practice medicine in the United States. (NCQA Standard)
• Graduate of an accredited medical school. M.D. or D.O. Degree is required. (NCQA Standard)
• 3-5 years of clinical practice in a primary care setting
• Deep understanding of managed care, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, and pharmacy management
• Strong record of continuing education activities (relevant to practice area and needed to maintain licensure)
• Demonstrated understanding of culturally responsive care
• Proven organizational and detail-orientation skills
• Ability to collaborate effectively with a staff, providers, and a diverse group of leaders.
• US work authorization

Nice To Haves

• Prior clinical leadership or supervision experience is preferred.

Responsibilities

• Lead and manage the Utilization Management team, providing guidance, training, and support to the day to day issues.
• Support recruiting, hiring, and retaining skilled UM clinical staff, fostering a collaborative and high-performance work environment alongside Manager, Utilization Management
• Conduct regular performance evaluations, offering feedback, coaching, and professional development opportunities.
• Monitor and evaluate the performance of the UM team, ensuring efficiency and effectiveness in all UM activities.
• Conduct and oversee clinical reviews of medical records to determine the medical necessity and appropriateness of healthcare services.
• Ensure timely and accurate review of prior authorizations, concurrent reviews, and retrospective reviews.
• Collaborate with healthcare providers to facilitate appropriate utilization of healthcare resources.
• Ensure compliance with all federal, state, and local regulations related to utilization management.
• Stay current with changes in healthcare regulations and standards affecting UM practices.
• Work closely with other departments, including Transitions, Case Management, and Care Teams, to ensure coordinated and integrated care.
• Serve as a clinical resource and advisor to the UM team and other departments.
• Other duties as assigned.

Benefits

• Mission-focused career impacting change and measurably improving health outcomes for medicare patients
• Paid vacation, sick time, and investment/retirement 401K match options
• Health insurance, vision, and dental benefits
• Opportunities for leadership development and continuing education stipends
• New centers and flexible work environments
• Opportunities for high levels of responsibility and rapid advancement
• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs

What This Job Offers

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