Manager, UM Medical Director (Remote In OH)

Manager, UM Medical Director (Remote in OH)

**This position can be remote anywhere within Ohio**

Manager, UM Medical Director

Provides leadership to AMD teams based upon specialty or geographic area and performs utilization management review in area of expertise. Fosters continuous improvement in policies, processes and all parts of the operations.

Responsibilities

• Oversee physician’s utilization review process and determinations.
• Participate in quality processes such as audits and quality improvement projects.
• Provide leadership support to assistant medical directors.
• Ensure physician compliance with clinical goals through monitoring of care management performance.
• Recommend changes and enhancements to current managed care, review guidelines, and clinical criteria based on clinical knowledge of health care delivery systems, utilization methods, reimbursement methods and treatment protocols.
• Provide guidance to assistant medical director team in the coordination of quality care.
• Performs other duties as assigned.

Qualifications

• MD or DO from an accredited medical school with an active, unrestricted (state) license to practice medicine in United States.
• Minimum of 5 years of established (clinical) care practice experience required.
• Physician reviewer experience in the insurance industry preferred.

Professional Certification(s):

• Board Certification, in nationally recognized specialty (ABMS or AOA) is required.
• Active Unrestricted license to practice medicine in US.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• Top Workplace in Northeast Ohio. Year after year we've received this recognition!
• On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
• On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
• Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
• Business Casual attire

Excellent Benefits and Compensation:

• Competitive compensation plans
• Employee bonus program
• 401(k) with company match and an additional company contribution
• Excellent medical, dental, vision, and disability insurance

An Investment in You:

• Career development programs and classes
• Mentoring and coaching to help you advance
• Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.