Job summary
Job post source
This job is directly from Florida Blue
Job overview
The Medical Director Care Management- Utilization Management role at Florida Blue involves leading utilization management reviews to ensure appropriate medical necessity decisions, impacting patient care and organizational compliance.
Responsibilities and impact
The Medical Director will perform utilization management reviews including pre-service, post-service, concurrent review, and appeals, discuss cases with providers, apply medical policies, collaborate with case managers, meet compliance metrics, participate in audits, assist staff, develop policies, and act as a subject matter expert.
Compensation and benefits
The position offers an annual salary range of $220,000 to $357,500 with typical hiring range $220,000 to $275,000, comprehensive benefits including medical, dental, vision, life insurance, income protection, leave programs, retirement plan with employer match, paid time off, and wellness programs.
Experience and skills
Candidates must have a current unrestricted Florida medical license, board certification or eligibility, 5+ years clinical experience, strong communication skills, and ability to work independently and in teams; utilization management or primary care specialty experience is preferred.
Work environment and culture
Florida Blue promotes a Be Well, Work Well, GuideWell culture emphasizing individual wellbeing and teamwork to serve members and communities effectively.
Company information
Florida Blue is a health insurance company focused on providing comprehensive health coverage and wellness programs to its members, committed to equal employment opportunity and inclusive work environment.
Job location and travel
This is a remote position allowing work from home.
Unique job features
The role includes leadership in utilization management with opportunities to influence medical and pharmacy policy development and participate in audits and quality assurance activities.
Company overview
Florida Blue, a subsidiary of GuideWell Mutual Holding Corporation, is a leading health solutions company based in Jacksonville, Florida. It primarily operates as a health insurance provider, offering a range of plans including individual, family, and Medicare options. The company generates revenue through premiums, administrative fees, and investment income. Founded in 1944, Florida Blue has a rich history of adapting to healthcare reforms and expanding its services to meet the evolving needs of its members.
How to land this job
Position your resume to highlight your medical license, board certification, and clinical experience, emphasizing your expertise in utilization management and physician peer reviews as outlined in the job description.
Focus on demonstrating your ability to perform pre-service, post-service, concurrent reviews, and appeals, along with collaboration skills with case managers and healthcare teams, which are critical for this role.
Apply through multiple channels including Florida Blue's corporate career site, LinkedIn, and reputable healthcare job boards to maximize your application reach.
Connect on LinkedIn with current Medical Directors or healthcare leadership at Florida Blue; use ice breakers like commenting on recent Florida Blue healthcare initiatives or asking about team culture and UM review processes.
Optimize your resume for ATS by incorporating keywords such as 'utilization management,' 'medical necessity,' 'peer to peer review,' 'clinical guidelines,' and 'medical policy' to ensure your resume passes automated screenings.
Utilize Jennie Johnson's Power Apply feature to automate tailored applications across multiple platforms, find relevant LinkedIn contacts, and optimize your resume for ATS, allowing you to focus more on networking and interview preparation.
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