Director Utilization Mgmt
Wellpath / Correct Care Solutions, Cleveland, OH, United States
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Position : Director Utilization Management (Relocation Bonus Available)
Compensation : $199,992 - $249,995.2 / year
Department : Regional Office Location: Lemoyne, Pennsylvania (Onsite)
You Matter
Make a difference every day in the lives of the underserved.
Join a mission‑driven organization with a people‑first culture.
Excellent career growth opportunities.
Caring for overlooked, underserved, and vulnerable patients.
Diversity, equity, inclusion, and belonging.
Autonomy in a warm team environment.
Growth and training.
Perks and Benefits
Comprehensive benefits including medical, dental, vision, paid time off, and 401(k).
DailyPay – receive your money as you earn it.
Tuition Assistance and dependent scholarships.
Employee Assistance Program (EAP) with free counseling and health coaching.
Company‑paid life insurance.
Tax‑free Health Spending Account (HSA).
Wellness program: fitness memberships and product discounts.
Preferred banking partnership with discounted rates for home and auto loans.
*Eligibility for perks and benefits varies by employee type and length of service.
How you make a difference The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within the assigned area. They provide guidance and direction to medical staff to ensure quality patient care and appropriate utilization of medical services. They serve as a key liaison with external partners and stakeholders and collaborate with internal teams to optimize care delivery and achieve operational goals.
Key Responsibilities
Ensure the use of nationally recognized criteria and evidence‑based standards for inpatient concurrent reviews and off‑site service requests.
Manage UM staff, including performance reviews, employee development, hiring, coaching, counseling, and retention.
Lead UM process improvements, facilitate patient care goals, and use data research to reduce length of inpatient stays and decrease ED admissions.
Evaluate and recommend policy improvements related to the utilization review system; provide UM updates and participate in meetings.
Establish and monitor progress toward UM program goals, maintain off‑site service and UM tracking/reporting, and facilitate regular meetings with partner hospital clinical staff regarding off‑site services.
Qualifications & Requirements Education
Medical Doctor (M.D.) or Osteopathic Doctor (D.O.) from an accredited university.
Experience
One (1) year of experience in utilization management is required.
Excellent communication and organizational skills required.
Experience in performance and/or quality improvement preferred.
Licenses/Certifications
Current medical license in the state of employment.
We are an Equal Employment Opportunity/Affirmative Action Employer We celebrate diversity and are committed to creating an inclusive environment for all employees.
If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles.
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Compensation : $199,992 - $249,995.2 / year
Department : Regional Office Location: Lemoyne, Pennsylvania (Onsite)
You Matter
Make a difference every day in the lives of the underserved.
Join a mission‑driven organization with a people‑first culture.
Excellent career growth opportunities.
Caring for overlooked, underserved, and vulnerable patients.
Diversity, equity, inclusion, and belonging.
Autonomy in a warm team environment.
Growth and training.
Perks and Benefits
Comprehensive benefits including medical, dental, vision, paid time off, and 401(k).
DailyPay – receive your money as you earn it.
Tuition Assistance and dependent scholarships.
Employee Assistance Program (EAP) with free counseling and health coaching.
Company‑paid life insurance.
Tax‑free Health Spending Account (HSA).
Wellness program: fitness memberships and product discounts.
Preferred banking partnership with discounted rates for home and auto loans.
*Eligibility for perks and benefits varies by employee type and length of service.
How you make a difference The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within the assigned area. They provide guidance and direction to medical staff to ensure quality patient care and appropriate utilization of medical services. They serve as a key liaison with external partners and stakeholders and collaborate with internal teams to optimize care delivery and achieve operational goals.
Key Responsibilities
Ensure the use of nationally recognized criteria and evidence‑based standards for inpatient concurrent reviews and off‑site service requests.
Manage UM staff, including performance reviews, employee development, hiring, coaching, counseling, and retention.
Lead UM process improvements, facilitate patient care goals, and use data research to reduce length of inpatient stays and decrease ED admissions.
Evaluate and recommend policy improvements related to the utilization review system; provide UM updates and participate in meetings.
Establish and monitor progress toward UM program goals, maintain off‑site service and UM tracking/reporting, and facilitate regular meetings with partner hospital clinical staff regarding off‑site services.
Qualifications & Requirements Education
Medical Doctor (M.D.) or Osteopathic Doctor (D.O.) from an accredited university.
Experience
One (1) year of experience in utilization management is required.
Excellent communication and organizational skills required.
Experience in performance and/or quality improvement preferred.
Licenses/Certifications
Current medical license in the state of employment.
We are an Equal Employment Opportunity/Affirmative Action Employer We celebrate diversity and are committed to creating an inclusive environment for all employees.
If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles.
#J-18808-Ljbffr