Medical Director for Health Plan

Evry Health is hiring a tech-savvy Medical Director to lead medical policy and utilization management for a growing, technology-enabled health plan. In this role, you will work closely with teams across actuarial, technology, care coordination, and medical quality management to shape how care is delivered, managed, and improved for our members. You will report directly to the Chief Medical Officer. While this is a remote role, you must reside in the United States and in the Eastern or Central time zone. We are also open to this role being full-time or part-time.

About Evry Health and Globe Life

We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives.

 

Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.

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Roles and Responsibilities

• Lead utilization management strategy, including oversight of medical necessity determinations and review processes
• Own medical policy development, incorporating regulatory updates and care guideline changes
• Lead and Partner with the Utilization Management Review Committee
• Provide medical oversight, expertise, and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members
• Promote positive relations with the local medical community, including periodic consultation with providers, facilities, caregivers, etc.
• Review case management data to identify trends, gaps in care, and recommend corrective actions
• Provide oversight and direction for staff and provider training and education
• Integrate clinical quality and best clinical practices into medical management program development
• Evaluate the development of new programs and the continuation of existing programs
• Investigate future care management and patient engagement technologies and evaluate their impact on providers’ practices, patient safety, and patient experience

Experience and Skills Desired

• Active, unrestricted Texas (TX) medical license without limitations or sanctions
• Doctor of Medicine (MD) with 8+ years of clinical experience; management experience preferred
• Board certification in a specialty recognized by the American Board of Medical Specialties
• Experience working within a health insurance plan, with an emphasis on population health
• Experience in managed care and utilization management, including performing utilization reviews within a health plan
• Strong knowledge of managed care systems, quality improvement, and clinical best practices
• Experience with MCG or other clinical guidelines

Telecommuting Requirements

Benefits Package

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Evry Health is an EEO employer - Read More Here

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