Utilization Management Director jobs in Nevada

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.

Position: Medical Director, Utilization Management

Medical Director is a physician leader responsible for medical oversight of the Utilization Management program at P3 Health Partners. The primary objective will be to enhance the quality, safety, effectiveness, and efficiency of utilization review inclusive of prior authorization, concurrent and respective review, discharge planning and transitions of care to the appropriate level. This role will provide medical leadership in clinical initiatives aimed at improving patient services, quality and safety outcomes, physician alignment and satisfaction, and implementing evidence-based programs, practices, and activities that deliver exceptional quality, service, and financial results.

The Medical Director is responsible for:

• Medical oversight of utilization management nationally
• Clinical resource and subject matter expert to clinical staff.
• Perform clinical reviews and conduct peer reviews
• Perform high dollar claims and complex case reviews
• Participate in inter-rater reliability activities
• Participate in MRA and Quality education directives
• Other duties as needed

Position Location:

This position is based at our P3 Health Partner headquarters office in Henderson, NV may travel to any of our markets as needed.

Required Education and Experience:

• Medical Doctor (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree from an accredited school.
• Board certification is required.
• Unrestricted state medical licenses in NV, OR, CA or AZ .
• 5 years clinical practice experience in primary care.
• 2 years of previous medical director experience working with Medicare Advantage preferred.
• 2 years of previous medical director experience working for a health plan or medical group in a utilization management or medical management capacity.
• Knowledge of utilization management to include experience applying medical management treatment guidelines and nationally recognized criteria, such as MCG (preferred), InterQual / McKesson, or other practical management guidelines required.
• Advanced training in healthcare administration is preferred (e.g., MHA, MBA, MMM, MPH).

Knowledge, Skills, and Abilities:

• Demonstrated ability to resolve complex problems effectively.
• Excellent judgment and decision-making skills.
• Proficiency in negotiating and handling conflict resolutions.
• Skilled in training and educating staff at all levels, including executives and providers, and demonstrating effective collaboration skills.
• Knowledgeable of contemporary practice issues within medicine and experienced in outcomes measurement of clinical quality and utilization.
• Familiarity with all aspects of medical group operations.
• Note: In addition to the qualifications mentioned above, the ideal candidate should possess strong leadership qualities, effective communication skills, and a commitment to continuous improvement in healthcare delivery. The ability to adapt to a dynamic and rapidly evolving healthcare environment is essential.

Education

• Masters or better

Licenses & Certifications

• DO License
• MD License

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)