Medical Director UM Inpatient Focus
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Job Location:
Henderson, NV - USA
Monthly Salary:
$ 215000 - 250000
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Overall Purpose
The Medical Director Utilization Management serves as the physician leader responsible for medical oversight of the Utilization Management (UM) program at P3 Health Partners. This role ensures the quality safety effectiveness and efficiency of utilization review processes including prior authorization concurrent and retrospective review discharge planning and transitions of care. The Medical Director provides clinical leadership to enhance patient outcomes promote physician alignment and satisfaction and drive implementation of evidence-based programs and best practices that improve quality service and financial performance across P3 Health Partners markets.
Essential Functions
- Provide national medical oversight of all utilization management functions ensuring alignment with organizational goals and compliance with regulatory and accreditation standards.
- Serve as a clinical resource and subject matter expert to utilization management nurses case managers and other clinical staff.
- Conduct peer reviews and clinical reviews for medical necessity determinations complex cases and high-cost claims.
- Participate in inter-rater reliability assessments to ensure consistency and accuracy of medical review decisions.
- Collaborate with Quality and Risk Adjustment teams on MRA and quality education initiatives to enhance outcomes and compliance.
- Partner with leadership to develop and refine utilization management policies protocols and criteria based on nationally recognized standards (e.g. MCG InterQual).
- Contribute medical expertise to case management and care coordination processes ensuring members transition to the appropriate level of care.
- Support physician engagement education and alignment through clear communication and collaboration with internal and external providers.
- Participate in ongoing evaluation and improvement of UM operations including metrics monitoring and performance review.
- Perform other duties as assigned to support clinical and operational initiatives.
Knowledge Skills and Abilities
- Strong analytical and problem-solving abilities with proven skill in resolving complex clinical and operational challenges.
- Excellent judgment decision-making and negotiation skills.
- Demonstrated proficiency in conflict resolution and collaborative leadership.
- Skilled in training and educating staff at all levels including clinicians executives and providers.
- In-depth understanding of utilization management principles medical management criteria and evidence-based practice guidelines (e.g. MCG InterQual).
- Knowledge of healthcare delivery systems medical group operations and value-based care principles.
- Familiarity with outcomes measurement quality improvement methodologies and regulatory compliance standards.
- Exceptional communication leadership and interpersonal skills with the ability to build trust and influence across clinical and administrative teams.
- Adaptability to thrive in a dynamic evolving healthcare environment and commitment to continuous improvement in patient care delivery.
Experience
- Minimum five (5) years of clinical practice experience in primary care required.
- Minimum two (2) years of medical director experience in a health plan medical group or utilization management/medical management role required.
- Previous experience with Medicare Advantage populations strongly preferred.
- Experience applying medical management treatment guidelines and nationally recognized criteria such as MCG (preferred) InterQual/McKesson or equivalent standards required.
- Experience conducting complex case reviews peer reviews and high-cost claim assessments.
- Advanced training in healthcare administration preferred (e.g. MHA MBA MMM MPH).
Education
- Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree from an accredited institution required.
Licenses
- Current board certification in area of clinical specialty required.
- Active unrestricted medical license(s) in one or more of the following states: Nevada Oregon California or Arizona required.
Position Location
This position is based at our P3 Health Partner headquarters office in Henderson NV and may travel to any of our markets as needed.
About P3
People. Passion. Purpose.
P3 is a patient-centered physician-led healthcare service with a big heart and an even bigger vision: to lead healthcare in a new direction by cultivating wellness not just managing illness. We do this by providing every patient with access to support that can help them manage their follow-up care. We also provide tools to help them get healthy stay well and live an active life.
Salary Range: $215000 - $250000
Required Experience:
Director
Key Skills
- EMR Systems
- Post Residency Experience
- Occupational Health Experience
- Clinical Research
- Managed Care
- Primary Care Experience
- Medical Management
- Utilization Management
- Clinical Development
- Clinical Trials
- Leadership Experience
- Medicare
About Company
P3 Health Partners is TRANSFORMING HEALTHCARE. We support healthier patients and communities. Driven by people, with passion and purpose—That’s the power of P3. P3 is a leader in population health ... Read more
