Utilization Review Director / MD - 22496962
Utilization Review Director / MD
Work Location: Port Huron, MI
InGenesis is currently sourcing for a Utilization Review Director to work with our potential client located in Port Huron, MI. This position is dependent on contract award. In this role, you will assist in the development and maintenance of an efficient utilization management program to meet the needs of health plan members.
If you meet the qualifications outlined below, apply now and we’ll reach out to answer any questions you may have!
- Educate primary care physicians regarding systems, structures, processes, and outcomes necessary for assurance of regulatory compliance.
- Develop strategies for improving all aspects of clinic.
- Participate in case review and medical necessity determination.
- Conduct post service reviews issued for medical necessity and benefits determination coding.
- Analyze aggregate data and report to primary care physician.
- Supervise functions of care coordination.
- Assess effectiveness of specialty network to ensure members have access to multi-specialties within their demographic area.
- Review policies and procedures of credentialing department and offer guidance for revision and implementation of process.
- Educate primary care network and assist in problem resolution.
- Assist in development of medical management protocols.
- Perform analysis of utilization data and suggest/implement corrective action plans with network physicians.
- Attend CE classes to keep abreast of medical advancements and innovative practice guidelines.
- Assist in growth and development of subordinates.
- Orient new physicians to ensure understanding of company policy and available resources for physician support.
- Perform other duties as assigned.
- Current MD license in state of Michigan.
- Board certified/board eligible Family Practitioner or Internal Medicine Specialist.
- 5+ years of clinical practice experience.
- 2+ years of experience in utilization management activities.
- Preferred:2+ years of experience working in a managed care health plan environment.
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.
InGenesis is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at [link removed]