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Medical Director Utilization Management Jobs in Bothell, WA

CHPW

Utilization Management Clinician I

Seattle, WA · On-site +1

$35.92 - $55.67/hr

About the Role The Level I Utilization Management Clinician performs utilization review for medical ... Communicate effectively with medical director regarding identified variances within the case ...

Key Works

Medical Director

Seattle, WA · On-site

$250K - $300K/yr

Medication Management & Process Oversight: * Provide direct oversight of the med room, including medication storage, security, access controls, and environmental standards. * Ensure accurate ...

Key Works

Medical Director

Seattle, WA

$250K - $300K/yr

Medication Management & Process Oversight: * Provide direct oversight of the med room, including medication storage, security, access controls, and environmental standards. * Ensure accurate ...

Health Pros Northwest

Medical Director

Everett, WA · On-site

$150/hr

Medical Doctor manages overall patient care regarding lifestyle and development issues ... Direct Deposit for your convenience * Paid Sick Leave * Backgrounds will be conducted upon all ...

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Medical Director Utilization Management information

See Bothell, WA salary details

$14.5K

$259.8K

$399.1K

How much do medical director utilization management jobs pay per year?

As of Jul 14, 2026, the average yearly pay for medical director utilization management in Bothell, WA is $259,762.00, according to ZipRecruiter salary data. Most workers in this role earn between $221,300.00 and $318,000.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Medical Director Utilization Management, and why are they important?

To thrive as a Medical Director Utilization Management, you need a medical degree (MD or DO), board certification, and extensive clinical experience, often in internal medicine or a related specialty. Familiarity with utilization review processes, case management software, and regulatory frameworks such as CMS guidelines is essential. Strong leadership, analytical thinking, and effective communication skills are crucial for guiding teams and collaborating with diverse stakeholders. These competencies ensure appropriate resource utilization, regulatory compliance, and high-quality patient care within healthcare organizations.

How does a Medical Director in Utilization Management typically collaborate with clinical teams and insurance providers?

A Medical Director in Utilization Management frequently works at the intersection of healthcare providers, clinical teams, and insurance companies. Their role involves reviewing clinical cases, making coverage determinations, and consulting with physicians to ensure that medical treatments are both necessary and cost-effective. Collaboration often includes participating in interdisciplinary meetings, providing guidance on complex cases, and communicating policy updates or clinical guidelines. This ensures that patient care decisions align with best practices, regulatory requirements, and payer policies.

What is a Medical Director Utilization Management?

A Medical Director of Utilization Management is a physician who oversees and ensures the appropriate use of medical resources within a healthcare organization or insurance company. Their responsibilities include reviewing clinical cases, developing utilization review policies, and working with healthcare providers to ensure that treatment plans are medically necessary and cost-effective. They play a key role in balancing patient care quality with regulatory and financial considerations, helping to improve healthcare outcomes and system efficiency.

What is the difference between Medical Director Utilization Management vs Medical Director Case Management?

AspectMedical Director Utilization ManagementMedical Director Case Management
CredentialsMedical degree, medical license, possibly board certificationMedical degree, medical license, possibly board certification
Work EnvironmentUtilization review departments, insurance companies, healthcare organizationsCase management teams, hospitals, healthcare providers
Employer & IndustryInsurance companies, managed care organizationsHospitals, healthcare systems, community health agencies
Primary FocusReviewing medical necessity and approving servicesCoordinating patient care and discharge planning

Both roles require medical credentials and involve improving patient care, but Medical Director Utilization Management primarily focuses on reviewing and approving healthcare services for insurance purposes, while Medical Director Case Management emphasizes coordinating ongoing patient care and discharge planning within healthcare settings.

What job categories do people searching Medical Director Utilization Management jobs in Bothell, WA look for? The top searched job categories for Medical Director Utilization Management jobs in Bothell, WA are:
What cities near Bothell, WA are hiring for Medical Director Utilization Management jobs? Cities near Bothell, WA with the most Medical Director Utilization Management job openings:
Medical Director Utilization Management jobs near you
Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE

Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE

Cambia Health Solutions

Bellevue, WA • Remote

Part-time

Medical, Dental, Vision, Retirement, PTO

Posted 6 days ago

New

Cambia Health Solutions rating

8.4

Company rating: 8.4 out of 10

Based on 32 frontline employees who took The Breakroom Quiz

101st of 281 rated insurance

Job description

Associate Medical Director Behavioral Health or Utilization Management Medical Director DOEWork from home within Oregon, Washington, Idaho or Utah

This is a part-time non-benefited position with a maximum of 12 hours per week.

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team of physicians are living our mission to make health care easier and lives better. As a member of the Utilization Management (UM) team, our Associate Medical Director BH and UM Medical Directors provides leadership, and clinical oversight for behavioral health operations across all lines of business within the health plan, with a primary focus on behavioral health utilization management. Partners with leaders and staff across the organization to ensure policies, programs and strategies related to our members. Conducts case reviews requiring physician involvement and/or provides clinical expertise to others related to behavioral health case management, prior authorizations and appeals. Provides peer-to-peer consultations with providers - all in service of creating a person-focused health care experience.

Are you a motivated and experienced medical professional looking for a new challenge? Do you have a passion for patient care and want to make a big difference in healthcare? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

  • Licensed Physician with an MD or DO degree

  • Active, unrestricted license to practice medicine in one or more of our 4 states.

  • Board Certification in general psychiatry or child psychiatry required with preference for being board certified in both.

  • Qualification by training and experience to render clinical opinions about medical conditions, procedures, and treatments under review.

  • At least 3 years clinical experience.

  • Two years health plan medical utilization management and/or case management experience.

  • Equivalent combination of education and experience.

  • Must be located in one of our four states.

Skills and Attributes:

  • In-depth knowledge of best practices related to medical care for a wide variety of behavioral health conditions.

  • Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to effectively manage patient care to improve outcomes.

  • Passion for population health, healthcare transformation and improving the experience of people with mental health issues.

  • Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes.

  • Proven ability to develop and maintain positive working relationships with community and provider partners.

  • Knowledge of the health insurance industry, state and federal regulations (including Parity Legislation/Regulations), provider reimbursement methods and evolving accountable care and payment models is preferred.

  • Experience conducting medical case reviews for utilization and/or case management is strongly preferred.

  • Detail-oriented with orientation to the application of data and metrics in managing health, quality and program effectiveness.

  • Leadership experience with demonstrated ability to effectively build relationships, work with others and lead people and project teams.

  • Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

  • Completes Behavioral Health utilization management reviews, including PA, appeals and post-service.

  • Develops and Implements Behavioral Health Policies and Programs: Assists in developing high-quality, market-competitive behavioral health medical policies and programs, and provides leadership in developing short and long-range plans, goals, and objectives for integrated utilization management.

  • Operational Leadership and Oversight: Oversees the development of effective operational policies, procedures, and standards for an integrated behavioral health program, monitors utilization and results, and implements process or system changes as needed.

  • Subject Matter Expert and Clinical Leadership: Serves as a subject matter expert on behavioral health, provides medical advice, oversight, and leadership for staff, and ensures members receive safe, effective, and cost-efficient services.

  • Collaboration and Communication: Collaborates with the Executive Medical Director of Behavioral Health, leads/participates in teams for medical policy reviews and development, and discusses review determinations with providers to promote understanding of utilization management and quality improvement policies.

  • Industry Trends and Opportunities: Stays abreast of industry, medical, and technology trends, identifies and communicates new opportunities to enhance outcomes and the organization's reputation, and collaborates to implement actions to reduce medical cost trend.

  • Other roles as assigned.

#LI-Remote

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.

Associate Medical Director

  • Oregon, Washington, Utah, and Idaho:The expected hiring range is$217,600 - $294,400, the full salary range is$204,000 - $333,000 and the bonus target is25%.

  • North Dakota:The expected hiring range is$217,171.97 - $293,820.91 and the full salary range is$192,827.15 - $318,165.72.

Medical Director

  • Oregon, Washington, Utah, and Idaho:The expected hiring range is$238,850 - $323,150, the full salary range is$224,000 - $366,000 and the bonus target is30%.

  • North Dakota:The expected hiring range is$252,506.91 - $341,626.99, the full salary range is$224,201.29 - $369,932.61 and the bonus target is20%.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

  • Work alongside diverse teams building cutting-edge solutions to transform health care.
  • Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
  • Grow your career with a company committed to helping you succeed.
  • Give back to your community by participating in Cambia-supported outreach programs.
  • Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

  • Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
  • Annual employer contribution to a health savings account.
  • Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
  • Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
  • Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
  • Award-winning wellness programs that reward you for participation.
  • Employee Assistance Fund for those in need.
  • Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

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