About the roleEvry 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.About Evry Health and Globe LifeWe 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.Roles and ResponsibilitiesLead utilization management strategy, including oversight of medical necessity determinations and review processesOwn medical policy development, incorporating regulatory updates and care guideline changesLead and Partner with the Utilization Management Review CommitteeProvide medical oversight, expertise, and leadership to ensure the delivery of cost effective, quality healthcare services to health plan membersPromote 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 actionsProvide oversight and direction for staff and provider training and educationIntegrate clinical quality and best clinical practices into medical management program developmentEvaluate the development of new programs and the continuation of existing programsInvestigate future care management and patient engagement technologies and evaluate their impact on providers’ practices, patient safety, and patient experienceExperience and Skills DesiredActive, unrestricted Texas (TX) medical license without limitations or sanctionsDoctor of Medicine (MD) with 8+ years of clinical experience; management experience preferredBoard certification in a specialty recognized by the American Board of Medical SpecialtiesExperience working within a health insurance plan, with an emphasis on population healthExperience in managed care and utilization management, including performing utilization reviews within a health planStrong knowledge of managed care systems, quality improvement, and clinical best practicesExperience with MCG or other clinical guidelinesTelecommuting RequirementsThis is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones. This position requires work during the stated business hours.Required to have a dedicated work area established that is separate from other living areas and provides information privacy.Ability to keep all company sensitive documents secure.Must live in a location that receives an existing high-speed internet connection/service.Benefits PackageCompetitive salaryComprehensive health, dental, and vision insurance as well as life and disabilityRetirement savings plan with company matchGenerous time off/vacationProfessional development opportunitiesFlexible and remote work environment
