Utilization Management Medical Director
Welcome to Elevance Health, a leading healthcare organization dedicated to improving the quality and accessibility of healthcare for all. We are currently seeking a talented and experienced Utilization Management Medical Director to join our team. In this role, you will play a critical role in ensuring the effective and efficient utilization of healthcare resources, ultimately improving patient outcomes and reducing costs. We are looking for a dynamic leader with a passion for healthcare, strong clinical expertise, and a drive for innovation. If you are ready to make a positive impact on the healthcare industry, we encourage you to apply for this exciting opportunity.
- Oversee and manage the utilization management process to ensure the appropriate utilization of healthcare resources.
- Develop and implement utilization management policies and procedures in accordance with industry best practices and regulatory requirements.
- Review and evaluate utilization data to identify trends, areas for improvement, and cost-saving opportunities.
- Collaborate with other departments and stakeholders to develop and implement strategies for improving patient outcomes and reducing costs.
- Provide guidance and support to utilization management staff, including training and performance evaluations.
- Serve as a clinical resource for utilization management staff, providing expertise and guidance on complex cases.
- Develop and maintain relationships with healthcare providers, including hospitals, physicians, and other providers, to facilitate effective utilization management.
- Participate in the development and implementation of quality improvement initiatives to enhance healthcare delivery and patient outcomes.
- Stay current on industry trends and advancements in healthcare technology to continuously improve utilization management processes.
- Assist in the development and management of utilization management budgets.
- Represent the organization in meetings and conferences related to utilization management.
- Collaborate with the leadership team to develop and implement strategic goals and objectives for the organization.
- Foster a culture of innovation and continuous improvement within the utilization management department.
- Ensure compliance with all relevant laws, regulations, and accreditation standards.
- Provide regular reports and updates to senior leadership on utilization management activities, outcomes, and performance.
Medical Degree: A Utilization Management Medical Director At Elevance Health Must Possess A Medical Degree From An Accredited Institution. This Ensures That The Individual Has A Strong Foundation In Medical Knowledge And Can Effectively Oversee Utilization Management Processes.
Board Certification: It Is Essential For The Medical Director To Be Board Certified In A Relevant Medical Specialty Such As Internal Medicine, Family Medicine, Or Pediatrics. This Certification Demonstrates A High Level Of Expertise And Ensures That The Individual Is Up-To-Date With The Latest Medical Practices.
Experience In Utilization Management: The Ideal Candidate For This Role Should Have Several Years Of Experience In Utilization Management, Preferably In A Leadership Position. This Will Ensure That They Have A Thorough Understanding Of The Utilization Management Process And Can Effectively Manage And Guide The Team.
Strong Analytical Skills: A Utilization Management Medical Director Must Possess Strong Analytical Skills To Review And Analyze Data Related To Utilization Patterns, Healthcare Trends, And Financial Outcomes. This Will Enable Them To Make Informed Decisions And Recommendations For Improving The Organization's Utilization Management Processes.
Leadership Abilities: As A Leader In The Utilization Management Department, The Medical Director Must Have Strong Leadership Skills. This Includes The Ability To Effectively Communicate, Delegate Tasks, And Motivate Team Members To Achieve Common Goals. They Should Also Be Able To Handle Conflicts And Make Difficult Decisions When Necessary.
Quality Assurance
Data Analysis
Utilization management
Medical Review
Cost Containment
prior authorization
Clinical Oversight
Utilization Analysis
Utilization Guidelines
Utilization Trends
Clinical Policies
Communication
Conflict Resolution
Leadership
Time management
creativity
Attention to detail
Teamwork
Adaptability
Problem-Solving
Empathy
According to JobzMall, the average salary range for a Utilization Management Medical Director in Indianapolis, IN, USA is $219,000-$346,000 per year. This can vary depending on factors such as the employer, experience, and qualifications of the individual.
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Elevance Health, Inc. is an American health insurance provider. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Empire BlueCross BlueShield in New York State, Anthem Blue Cross in California,Wellpoint, and Carelon.It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within their affiliated companies' health plans. Prior to June 2022, Elevance Health was named Anthem, Inc.
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