Medical Director, UM - Utilization Management
San Diego, CaliforniaJOB SUMMARY:
The Medical Director, UM is a clinical subject-matter expert for the Utilization Management Team and shall assist in the oversight of all UM activities. This position serves as a resource to providers and staff while furnishing guidance in areas of clinical quality, practice patterns, utilization management, case management, and patient satisfaction. This position is accountable for establishing quality standards and measuring outcomes as directed by the RCHN Senior Medical Director, and VP, Network Ops & Clinical Integration. This position is responsible for creating and ensuring an environment in which excellence of patient care is maintained, while encouraging timely, efficient, and effective clinical care.
MINIMUM QUALIFICATIONS:
M.D
5 Years of Experience
Active and current California unrestricted medical license
Board certification in pediatrics or a recognized pediatric subspecialty
5 years clinical experience in pediatrics or subspecialty pediatrics
Sound clinical knowledge and recognized as a credible clinical resource
Sound understanding of evidence-based medicine
Advanced written, oral and interpersonal communication skills
Excellent computer skills, tactical planning, and organizational skills
Demonstrated willingness and ability to interact successfully with providers, health plans, team members, family members, and administrators
Demonstrated commitment to valuing diversity and contributing to an inclusive working and learning environment
PREFERRED QUALIFICATIONS:
7 Years of Experience
Previous knowledge of health plan operations, clinical issues, trends and medical management, utilization management, quality management, contracting, benefits interpretation, and provider relations
The current salary range for this position is $99.62 to $136.99
Rady Children’s Hospital is committed to compensation that is externally competitive and internally equitable. We demonstrate this commitment by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit, healthcare sector. The range listed above does not represent the full salary range for the position but is the expected hiring range for qualified candidates. Compensation decisions consider a variety of factors including experience, education, licensure, unique skillsets, organizational need, and internal equity. This posting will remain open from the “date posted” until the hiring manager has determined there is a sufficient applicant pool or until the position is filled.