Insurance Utilization Review Jobs in Washington, DC

About the Job

System Medical Director of Physician Advisor Services

MedStar Health is seeking a System Medical Director with at least 7 years' experience to lead our Physician Advisor Services. This dynamic leadership role offers the perfect blend of strategic influence and clinical impact across our health system. As System Medical Director of Physician Advisor Services, you'll build, lead and manage a team of physician advisors while shaping the future of our physician advisor program. You'll actively serve as a physician advisor yourself while coaching team members and driving accountability for results. Your leadership will be instrumental in developing performance metrics that improve length of stay management and resource utilization throughout our enterprise.

We believe great leadership is built on trust and relationships. That's why we ask that this role begins with a meaningful on-site presence - typically during the first 12-18 months - to establish strong connections with your team, physician leaders, and hospital partners, and to lay a solid foundation for the program. As those relationships mature and the program stabilizes, we are committed to working with you toward a more flexible hybrid arrangement that reflects the confidence we've built together.

In this role, you'll:

* Build, coach, and manage a high performing physician advisor team

* Drive length of stay improvements through strategic program development

* Review critical cases referred by utilization review and case management teams

* Guide your physician advisor team with best practices and case assignments

* Collaborate with physician leaders, hospital executives, and key departments including finance, compliance, and clinical care transformation

* Champion efficient, high quality patient care and effective discharge planning

This position offers a rare opportunity to make a meaningful difference at both the strategic and clinical levels. You'll help strengthen care coordination and drive improvement initiatives that impact patient outcomes across MedStar Health.

At MedStar Health, you can expect:

* A competitive base salary commensurate with experience

* Performance incentive compensation tied to program outcomes and quality metrics

* Medical, dental, and vision insurance

* Paid malpractice insurance

* Paid Time Off

* Retirement plan

Education/Training:

* Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) - Board Certification required

* Preferred: Additional certification in healthcare administration, business, or physician advisory

Experience:

* Minimum 7 years of physician advisory experience and direct clinical practice

* Strong knowledge of case management, utilization review, regulatory standards, denials management, observation medicine, and length of stay

* Familiarity with MCG and InterQual clinical criteria

Licensure/Certification:

* Current medical license in the practicing state

* Board Certified

* Preferred: ACPA-C or ABQUARP certification in Physician Advisory (or willingness to obtain within 1 year of hire)

The hiring range will also be $290,000 - $390,000

#DOX-6

This position has a hiring range of
USD $290,000.00 - USD $390,000.00 /Yr.

Apply

In addition to your salary, MedStar Health offers a comprehensive healthcare package (including medical, dental and vision subject to eligibility requirements) and other benefits. The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by MedStar Health. MedStar Health is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
The hiring range is the range MedStar Health, in good faith, believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on work experience, education and/or skill level, etc. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in MedStar Health's sole discretion unless and until paid and may be modified at MedStar Health's sole discretion, consistent with the law.
Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:

• Strong emphasis on teamwork-our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.

• Strategic focus on equity, inclusion, & diversity-we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.

• Comprehensive total rewards package-including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.

• More career opportunities closer to home-as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.

MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health entities that are federal government contractors are Equal Opportunity and Affirmative Action employers. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.

Please click here to view the full job description