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Utilization Management Medical Director - FM/IM/Geri

Medical Edge Recruitment

Tampa, FL

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JOB DETAILS
SKILLS
Analysis Skills, Behavioral Health, Case Management, Communication Skills, Content Management Systems (CMS), Cost Analysis, Diabetes, Emergency Care, Family Medicine, Geriatrics, Healthcare, Internal Medicine, Leadership, Medicare, National Committee for Quality Assurance (NCQA), Patient Care, Pharmacy, Preventive Medicine, Primary Care, Quality Management, Regulations, Reporting Dashboards, Risk, Social Work, Utilization Management
LOCATION
Tampa, FL
POSTED
4 days ago
Utilization Management Medical Director Primary Care Organization | Florida | Full Time

Most utilization management roles ask a physician to say no. This one asks you to build the system that makes the right answer obvious.

You will sit at the center of a primary care organization that carries real risk on its patients, which means every decision you make about the right care in the right setting shows up in outcomes and in performance. You are not reviewing charts in isolation. You are shaping how an entire clinical enterprise thinks about appropriateness, transitions, and total cost of care.

This is a physician leadership seat with executive visibility. You present to leadership. You set policy. You influence practice patterns across the network.
What You Will Own
Clinical leadership. Physician oversight and accountability for utilization management and population health. You are the physician advisor clinicians, case managers, and care management teams call when a case is complex and the path forward is unclear.

Utilization strategy. Prospective, concurrent, and retrospective review. Fewer avoidable emergency department visits. Fewer preventable admissions and readmissions. Appropriate use of diagnostics, pharmacy, specialty, hospital, and skilled nursing services.

Care coordination. Partnership with care management, pharmacy, behavioral health, and social work. Clean transitions after hospital and skilled nursing stays. Interdisciplinary case conferences on the patients who need the most attention.

Quality and value. Alignment of utilization strategy with quality improvement, risk adjustment, and value based contract performance.

Policy and governance. Utilization management policy grounded in evidence based guidelines and compliant with CMS, NCQA, state, and payer requirements. A seat on clinical governance committees.

Provider engagement. Practice pattern feedback, education, and the kind of physician to physician credibility that moves behavior.

Data. Utilization dashboards, cost driver analysis, and recommendations that reach executive leadership.
What Success Looks Like
Emergency department and inpatient utilization trending down. Readmissions inside 30 days trending down. Observation and inpatient status decisions landing correctly. Total cost of care improving while diabetes, hypertension, and preventive care measures improve alongside it. Value based contracts performing. Patients reporting that their care felt coordinated.
Who Fits
  • MD or DO with an active unrestricted license
  • Board certification in Family Medicine, Internal Medicine, or Geriatrics preferred
  • Five or more years of clinical practice in primary care
  • Leadership exposure to utilization management, care management, or population health preferred
  • Working knowledge of value based models: ACO, Medicare Advantage, MSSP, commercial risk
  • Command of CMS regulations and quality programs
  • Fluency in healthcare analytics and the ability to turn a dashboard into a decision
  • The communication skill to influence physicians who do not report to you
Compensation
Competitive physician executive compensation with performance incentive, full benefits, malpractice coverage, and CME support. Specifics are discussed openly on the first call.
Next Step
I am running this search directly and I can tell you things a posting cannot: the organization, the leadership you would report to, the size of the population, and why this seat is open right now.

One conversation, fifteen minutes, and you will know whether this is worth your time.

Christian Claudio StaffMed Health Partners cclaudio@staffmedhp.com | 214.208.3022 (call or text)
Utilization Management Medical Director Primary Care Organization | Florida | Full Time

Most utilization management roles ask a physician to say no. This one asks you to build the system that makes the right answer obvious.

You will sit at the center of a primary care organization that carries real risk on its patients, which means every decision you make about the right care in the right setting shows up in outcomes and in performance. You are not reviewing charts in isolation. You are shaping how an entire clinical enterprise thinks about appropriateness, transitions, and total cost of care.

This is a physician leadership seat with executive visibility. You present to leadership. You set policy. You influence practice patterns across the network.
What You Will Own
Clinical leadership. Physician oversight and accountability for utilization management and population health. You are the physician advisor clinicians, case managers, and care management teams call when a case is complex and the path forward is unclear.

Utilization strategy. Prospective, concurrent, and retrospective review. Fewer avoidable emergency department visits. Fewer preventable admissions and readmissions. Appropriate use of diagnostics, pharmacy, specialty, hospital, and skilled nursing services.

Care coordination. Partnership with care management, pharmacy, behavioral health, and social work. Clean transitions after hospital and skilled nursing stays. Interdisciplinary case conferences on the patients who need the most attention.

Quality and value. Alignment of utilization strategy with quality improvement, risk adjustment, and value based contract performance.

Policy and governance. Utilization management policy grounded in evidence based guidelines and compliant with CMS, NCQA, state, and payer requirements. A seat on clinical governance committees.

Provider engagement. Practice pattern feedback, education, and the kind of physician to physician credibility that moves behavior.

Data. Utilization dashboards, cost driver analysis, and recommendations that reach executive leadership.
What Success Looks Like
Emergency department and inpatient utilization trending down. Readmissions inside 30 days trending down. Observation and inpatient status decisions landing correctly. Total cost of care improving while diabetes, hypertension, and preventive care measures improve alongside it. Value based contracts performing. Patients reporting that their care felt coordinated.
Who Fits
  • MD or DO with an active unrestricted license
  • Board certification in Family Medicine, Internal Medicine, or Geriatrics preferred
  • Five or more years of clinical practice in primary care
  • Leadership exposure to utilization management, care management, or population health preferred
  • Working knowledge of value based models: ACO, Medicare Advantage, MSSP, commercial risk
  • Command of CMS regulations and quality programs
  • Fluency in healthcare analytics and the ability to turn a dashboard into a decision
  • The communication skill to influence physicians who do not report to you
Compensation
Competitive physician executive compensation with performance incentive, full benefits, malpractice coverage, and CME support. Specifics are discussed openly on the first call.
Next Step
I am running this search directly and I can tell you things a posting cannot: the organization, the leadership you would report to, the size of the population, and why this seat is open right now.

One conversation, fifteen minutes, and you will know whether this is worth your time.

Christian Claudio StaffMed Health Partners cclaudio@staffmedhp.com | 214.208.3022 (call or text)

About the Company

M

Medical Edge Recruitment

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