CareMore Health System
Medical Director page is loaded## Medical Directorremote type:
Remote - Full Timelocations:
US-California-Remote:
Connecticut, USA:
California, USA:
District of Columbia, USA:
Montana, USAtime type:
Full timeposted on:
Posted 5 Days Agojob requisition id:
M101457**Job Description Summary**The Utilization Management (UM) Medical Director provides clinical leadership for the UM program, ensuring members receive appropriate, high-quality care. You will oversee review guidelines, collaborate with internal teams and external partners, and drive compliance with regulatory and accreditation standards.**How will you make an impact & Requirements****\*\*This is a remote position; however, candidates located in CA, NV, or AZ are preferred.\*\***CareMore Health is a physician-founded and physician-led organization that has been transforming care delivery since 1992. With 25 clinics, 65,000+ members and partnerships with 30+ health plans, we’ve built a reputation for delivering exceptional, integrated healthcare experiences to Medicare, Medicaid, and group or private plan members.Our mission is simple: to improve health outcomes by delivering a transformative and integrated healthcare experience impacting physical, social and emotional well-being. Cultivating life-long relationships with patients, grounded in compassion and unwavering dedication to excellence in care, we’ve built care teams around our patients’ needs — including doctors, nurse practitioners, case managers, community health workers, social workers, pharmacists and specialists, all working together to produce the best outcomes possible. This people-first, value-based model ensures physicians can practice medicine the way it was meant to be practiced — with time to connect, collaborate, and truly care for patients.**Key Responsibilities*** Lead the development, implementation, and periodic review of UM policies and clinical criteria* Provide physician oversight for concurrent and retrospective review activities* Approve and interpret clinical guidelines, pathways, and criteria for admission, continued stay, and discharge* Serve as the primary clinical liaison with payers, providers, and regulatory bodies* Mentor and educate UM nurses, physician reviewers, and other staff on best practices* Analyze utilization data and quality metrics to identify trends and areas for improvement* Participate in appeals and peer-to-peer discussions to resolve clinical disputes* Maintain compliance with NCQA, URAC, CMS, state regulations, and organizational standards* Participation in the physician call rotation, requiring coverage for one full weekend (Saturday and Sunday) approximately every four to five weeks. As compensation, one half-day of flex time (AM or PM) is provided during the following work week**Qualifications*** Medical degree (MD or DO) from an accredited institution* Active, unrestricted medical license in [State/Region]* Board certification in an acute-care specialty (e.g., Internal Medicine, Family Medicine, Pediatrics)* Minimum of 5 years clinical practice experience, with 2+ years in utilization management or managed care**Location*** Preference for candidates in CA, NV, or AZ* Requires availability to work standard Pacific Time Zone business hours, regardless of physical location**\*\*The posted compensation range represents the national market average. Compensation for roles located in premium or high-cost geographic markets may fall above this range. This position is bonus eligible based on individual and company performance.\*\*****Compensation:**$0.00to$At CareMore Health, we provide effective Advanced Primary Care and Palliative Care by seeing the whole person — body, mind, and spirit. We do it with doctors and nurses who provide personalized and compassionate care, nationally recognized disease prevention and management programs, and healthy-living plans. It helps patients get healthier, while receiving the healthcare experience they’ve always wanted.Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. The Business Units which comprise Mosaic Health are multi-payer and serve nearly one million consumers across 19 states, providing them with access to high quality primary care, integrated care teams, personalized navigation, expanded digital access, and specialized services for higher-need populations. Through Mosaic Health, health plans and employers have an even stronger care provider partner that delivers affordability and superior experiences for their members and employees, including value-based primary care capacity integrated with digital patient engagement and navigation. Each of the companies within Mosaic Health provide unique offerings that together promise to improve individuals' health and wellbeing, while helping care providers deliver higher quality care. For more information, please visit www.mosaichealth.com.Mosaic Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.If you require an accommodation for the application or interview process, please let us know and we will work with you to meet your needs. Please contact recruiting@mosaichealth.com for assistance. #J-18808-Ljbffr
Remote - Full Timelocations:
US-California-Remote:
Connecticut, USA:
California, USA:
District of Columbia, USA:
Montana, USAtime type:
Full timeposted on:
Posted 5 Days Agojob requisition id:
M101457**Job Description Summary**The Utilization Management (UM) Medical Director provides clinical leadership for the UM program, ensuring members receive appropriate, high-quality care. You will oversee review guidelines, collaborate with internal teams and external partners, and drive compliance with regulatory and accreditation standards.**How will you make an impact & Requirements****\*\*This is a remote position; however, candidates located in CA, NV, or AZ are preferred.\*\***CareMore Health is a physician-founded and physician-led organization that has been transforming care delivery since 1992. With 25 clinics, 65,000+ members and partnerships with 30+ health plans, we’ve built a reputation for delivering exceptional, integrated healthcare experiences to Medicare, Medicaid, and group or private plan members.Our mission is simple: to improve health outcomes by delivering a transformative and integrated healthcare experience impacting physical, social and emotional well-being. Cultivating life-long relationships with patients, grounded in compassion and unwavering dedication to excellence in care, we’ve built care teams around our patients’ needs — including doctors, nurse practitioners, case managers, community health workers, social workers, pharmacists and specialists, all working together to produce the best outcomes possible. This people-first, value-based model ensures physicians can practice medicine the way it was meant to be practiced — with time to connect, collaborate, and truly care for patients.**Key Responsibilities*** Lead the development, implementation, and periodic review of UM policies and clinical criteria* Provide physician oversight for concurrent and retrospective review activities* Approve and interpret clinical guidelines, pathways, and criteria for admission, continued stay, and discharge* Serve as the primary clinical liaison with payers, providers, and regulatory bodies* Mentor and educate UM nurses, physician reviewers, and other staff on best practices* Analyze utilization data and quality metrics to identify trends and areas for improvement* Participate in appeals and peer-to-peer discussions to resolve clinical disputes* Maintain compliance with NCQA, URAC, CMS, state regulations, and organizational standards* Participation in the physician call rotation, requiring coverage for one full weekend (Saturday and Sunday) approximately every four to five weeks. As compensation, one half-day of flex time (AM or PM) is provided during the following work week**Qualifications*** Medical degree (MD or DO) from an accredited institution* Active, unrestricted medical license in [State/Region]* Board certification in an acute-care specialty (e.g., Internal Medicine, Family Medicine, Pediatrics)* Minimum of 5 years clinical practice experience, with 2+ years in utilization management or managed care**Location*** Preference for candidates in CA, NV, or AZ* Requires availability to work standard Pacific Time Zone business hours, regardless of physical location**\*\*The posted compensation range represents the national market average. Compensation for roles located in premium or high-cost geographic markets may fall above this range. This position is bonus eligible based on individual and company performance.\*\*****Compensation:**$0.00to$At CareMore Health, we provide effective Advanced Primary Care and Palliative Care by seeing the whole person — body, mind, and spirit. We do it with doctors and nurses who provide personalized and compassionate care, nationally recognized disease prevention and management programs, and healthy-living plans. It helps patients get healthier, while receiving the healthcare experience they’ve always wanted.Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. The Business Units which comprise Mosaic Health are multi-payer and serve nearly one million consumers across 19 states, providing them with access to high quality primary care, integrated care teams, personalized navigation, expanded digital access, and specialized services for higher-need populations. Through Mosaic Health, health plans and employers have an even stronger care provider partner that delivers affordability and superior experiences for their members and employees, including value-based primary care capacity integrated with digital patient engagement and navigation. Each of the companies within Mosaic Health provide unique offerings that together promise to improve individuals' health and wellbeing, while helping care providers deliver higher quality care. For more information, please visit www.mosaichealth.com.Mosaic Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.If you require an accommodation for the application or interview process, please let us know and we will work with you to meet your needs. Please contact recruiting@mosaichealth.com for assistance. #J-18808-Ljbffr