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JOB SUMMARY:

Join a diverse and dynamic team of physicians and nurses working with the Rady Children’s Health Network. The Utilization Management Medical Director will collaborate closely with the clinical team to ensure that healthcare services are appropriately utilized while maintaining high standards of care and quality. The ideal candidate will have a strong pediatric clinical background. Utilization management experience is a plus. This position is part time with full benefits with a remote work option.

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:

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.

EOE including disability/vet