Medical Director for Health Plan (Full-time or Part-time)
Evry Health · United States
- Hybrid
- Part-time
- $200,000 / year
- United States
Job highlights
- Lead medical policy and utilization management.
- Shape care delivery for health plan members.
- Collaborate across multiple departments.
- Remote role within US, EST/CST time zones.
- Full-time or part-time options available.
About the role
Medical Director
Evry Health is seeking a tech-savvy Medical Director to lead medical policy and utilization management for a growing, technology-enabled health plan. This role involves collaboration with actuarial, technology, care coordination, and medical quality management teams to shape care delivery, management, and improvement for members. You will report directly to the Chief Medical Officer. This is a remote role, but candidates must reside in the United States within the Eastern or Central time zone. The position can be either full-time or part-time.
About Evry Health And Globe Life
Evry Health is dedicated to bringing humanity to health insurance through high-technology health plans that offer expanded benefits, increased access and transparency, and a personalized, human approach to help members live healthier lives. Evry Health is the major medical division of Globe Life (NYSE:GL), a company with a long history of stability and a strong financial rating.
Roles And Responsibilities
- Lead utilization management strategy, including oversight of medical necessity determinations and review processes.
- Own medical policy development, incorporating regulatory updates and care guideline changes.
- Lead and partner with the Utilization Management Review Committee.
- Provide medical oversight, expertise, and leadership to ensure cost-effective, quality healthcare services.
- Promote positive relations with the local medical community.
- Review case management data to identify trends, gaps in care, and recommend corrective actions.
- Provide oversight and direction for staff and provider training and education.
- Integrate clinical quality and best practices into medical management program development.
- Evaluate the development of new programs and the continuation of existing programs.
- Investigate future care management and patient engagement technologies and assess their impact.
Experience And Skills Desired
- Active, unrestricted Texas (TX) medical license without limitations or sanctions.
- Doctor of Medicine (MD) with 8+ years of clinical experience; management experience preferred.
- Board certification in a specialty recognized by the American Board of Medical Specialties.
- Experience working within a health insurance plan, with an emphasis on population health.
- Experience in managed care and utilization management, including performing utilization reviews within a health plan.
- Strong knowledge of managed care systems, quality improvement, and clinical best practices.
- Experience with MCG or other clinical guidelines.
Telecommuting Requirements
- This is a fully remote position, with the company headquarters in Dallas, Texas.
- Company business hours are weekdays 9-5 CST.
- Candidates must reside in the United States and be in the CST or EST time zones.
- Requires a dedicated, private work area.
- Must be able to keep all company sensitive documents secure.
- Must live in a location with a high-speed internet connection.
Benefits Package
- Competitive salary.
- Comprehensive health, dental, and vision insurance, life, and disability coverage.
- Retirement savings plan with company match.
- Generous time off/vacation.
- Professional development opportunities.
- Flexible and remote work environment.
Key Skills/Competency
- Medical Director
- Health Plan
- Utilization Management
- Medical Policy
- Managed Care
- Population Health
- Clinical Quality
- Healthcare Leadership
- Provider Relations
- Remote Work
Skills & topics
- Medical Director
- Health Plan
- Utilization Management
- Medical Policy
- Managed Care
- Population Health
- Clinical Quality
- Healthcare Leadership
- MD
- Remote
How to get hired
- Customize your resume: Highlight your medical leadership, utilization management, and health plan experience, tailoring it to the Medical Director role at Evry Health.
- Craft a compelling cover letter: Express your passion for Evry Health's mission and how your expertise aligns with their tech-enabled approach to health insurance.
- Prepare for AI screening: Be aware that AI tools may assist in initial application reviews; ensure your resume contains relevant keywords from the job description.
- Research company values: Understand Evry Health's commitment to bringing humanity to health insurance and their technology-driven solutions.
- Network and inquire: If possible, connect with current Evry Health employees on LinkedIn to gain insights into the team and culture.
Technical preparation
Review MCG or similar clinical guideline software.,Familiarize with managed care system functionalities.,Understand population health data analysis techniques.,Prepare to discuss technology's role in healthcare.
Behavioral questions
Describe leading policy development.,How do you ensure quality care delivery?,Share an experience in provider relations.,Discuss managing utilization review processes.
Frequently asked questions
- What is the work arrangement for the Medical Director position at Evry Health?
- The Medical Director role at Evry Health is a fully remote position. While the company headquarters are in Dallas, Texas, employees work remotely. You must reside in the United States and be within the Eastern or Central time zones to be considered for this role.
- Can I apply for the Medical Director role if I am not in Texas?
- Yes, you can apply for the Medical Director position even if you are not in Texas. The key requirement is that you must reside in the United States and be located within the Eastern or Central time zones. An active, unrestricted Texas medical license is preferred, but other active, unrestricted licenses may be considered depending on role needs.
- Is the Medical Director position at Evry Health full-time or part-time?
- Evry Health is flexible regarding employment type for the Medical Director role. You can apply for either a full-time or part-time position, offering flexibility to suit your career needs.
- What technical skills are most important for the Medical Director role at Evry Health?
- The Medical Director role emphasizes being 'tech-savvy' and involves working with a 'technology-enabled health plan.' Experience with managed care systems, population health initiatives, and familiarity with clinical guideline software like MCG are highly valued. An understanding of how technology impacts healthcare delivery and patient experience is crucial.
- What is the expected clinical experience for the Medical Director role?
- The ideal candidate for the Medical Director position will have at least 8 years of clinical experience as a Doctor of Medicine (MD). While management experience is preferred, a strong foundation in clinical practice is essential. Board certification in a specialty recognized by the American Board of Medical Specialties is also required.
- How does Evry Health use AI in its hiring process for the Medical Director role?
- Evry Health may utilize AI tools to assist with parts of the hiring process, such as reviewing applications and analyzing resumes for the Medical Director position. These tools are intended to support the recruitment team and do not replace human judgment. Final hiring decisions are made by humans.
- What kind of collaboration is expected in the Medical Director role?
- As a Medical Director at Evry Health, you will collaborate closely with various teams, including actuarial, technology, care coordination, and medical quality management. This cross-functional teamwork is essential for shaping how care is delivered, managed, and improved for health plan members.