Utilization Management Medical Director-NV

Location
Las Vegas, Nevada
Posted
Jun 16, 2022
Ref
R34104
Position Type
Permanent
Job Description:

Intermountain Healthcare is a system of 24 hospitals, a broad range of clinics and services,160 clinics, a Medical Group of 2,400+ employed physicians and advanced practitioners, and health insurance plans from SelectHealth. Ranked in the top five of our nation's health systems for quality, cost, and innovation, Intermountain Healthcare brings 45 years' experience in making care more accessible and affordable.

Intermountain Healthcare is looking for a Medical Director for Utilization Management to join our team in Nevada. The Nevada-based medical group is a non-profit entity of Intermountain Healthcare. Being a part of Intermountain Healthcare means embarking on a career filled with opportunities, strength, innovation, and fulfillment. We offer competitive pay with financial incentives for yielding strong metrics on quality care. Our clinicians receive an excellent benefit package, including CME reimbursement, paid license renewals, generous PTO, and much more. Take advantage of personal and professional growth opportunities including leadership pathways, charitable sponsorships, and volunteer opportunities.

If you're ready to join our Mission in helping people live the healthiest lives possible, please apply now , or contact Anita Prince, Physician Recruiter at aprince@imailnv.org| 702-528-6276.

This position interacts with utilization management, claims, network management, and finance. As the Medical Director, UM you are responsible for the appropriate utilization of medical services within established guidelines and for assuring that quality medical care is being delivered to our patients. In this role, you will develop, implement and administer policies and procedures for utilization of inpatient, ancillary, and specialty services throughout the care continuum. Must be knowledgeable of State and Federal regulatory agencies standard, related to health care organizations, which includes Medicare coverage criteria.

We offer competitive pay with financial incentives for yielding strong metrics on quality care. Our clinicians receive an excellent benefit package, including CME reimbursement, paid license renewals, generous PTO, and much more. Take advantage of personal and professional growth opportunities offered at Intermountain Healthcare, including leadership pathways, charitable sponsorships, and volunteer opportunities.

Our combined strengths and a shared cultural commitment as community-focused health systems with deep, personal connections to the people we serve allow us to focus on moving southern Nevada forward. Intermountain Healthcare is ranked in the top five of our nation's health systems for quality, cost, and innovation, and brings 45 years' experience in making care more accessible and affordable.

Essential Functions
  • Must have a demonstrated record related to case management, utilization management, quality management, discharge planning or other cost management program.
  • Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Engages in peer to peer conversations to guide and support deliver of evidence-based care. This includes review of complex, controversial or experimental medical services.
  • Five years in a professional setting such as hospital, clinic or home health environment.
  • Strong analytical and problem solving skills
  • Effective communication and interpersonal skills
  • Contribute to and supports the corporation's quality initiatives by planning, communicating, and encouraging team and individual contributions toward the corporation's quality improvement efforts.
  • Timely documentation and reporting
  • Provide oversight in the following areas, ASC utilization management, ER/K management, and serve as the chair designated committees defined by the organization.
  • Possess a strong progressive and customer-focused approach to building and maintaining customer and provider relations.
  • Statistical and fiscal data collection and interpretation

Position Details
  • Schedule: Monday-Friday, 8 am-5 pm
  • No Call
  • Practice location - Corporate Office

Requirements
  • Must have or be eligible to have a current and unrestricted Nevada medical license
  • Minimum of 5 years work experience related to case management, utilization management, quality management, discharge planning or other cost management.
  • Board Certified in Internal Medicine, Family Practice or other primary care specialty
  • Current Nevada DEA certificate required prior to start date
  • Current Nevada Pharmacy license required prior to start date
  • BLS/ACLS certification prior to start date

Physical Requirements:

Location:
Nevada Central Office

Work City:
Las Vegas

Work State:
Nevada

Scheduled Weekly Hours:
40

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