Practice Opportunities - Information
Specialty: Medical Director, Utilization Management - SHSSR
Location: Sutter Health Sacramento Sierra Region
(Sutter Medical Group)
Medical Director, Utilization Management
The primary responsibility of the Sutter Medical Group Medical Director for Utilization Management is to provide leadership and clinical direction for SMG's managed care programs, including utilization management, case management, financial analysis, policies, and ongoing clinician education.
FTE: Total FTE 1.0
UM Administrative FTE: .25-.5: It is anticipated that the incumbent will begin their role as .25 FTE and FTE will increase to .5 over a six to twelve month period. Further revisions in FTE will depend on alterations to job functions.
Clinical FTE .5-.75 (based on UM administrative FTE)
Job Functions: (include but are not limited to)
1. Regular case review and consultation with case managers, both in ambulatory and acute settings
2. Development of review process for service authorizations/denials that meets compliance standards with the health plans
3. Evaluate requests for medical services that require Medical Director approval, including out-of-network services and provider appeals
4. Develop strategies to address identified areas of improvement in appropriate utilization of services
5. Discuss cases with Health Plan Medical Directors as required to come to resolution
6. Help develop a managed care dashboard for both specialty and primary care physicians
7. Identify specialty departments where drill down reports can identify variation reduction projects
8. In conjunction with SPA Administration, implement and assist in the management of the market share caps
9. Develop ability to participate in network contracting
10. Work in conjunction with SPA Administration in developing SPA budget
11. Maintain effective working relationships with SIP leadership
A. Board Certified, M.D. or D.O, with a valid California License to practice medicine, with 5 years experience in clinical practice
B. Prior experience with utilization review and/or medical management experience is preferred, but not required
C. Positive interpersonal skills such to foster positive communications and working relationships with physicians, executive and administrative staff
The Sacramento Sierra Region offers all the advantages of living in Northern California.
The region offers cultural diversity, as well as ample outdoor activities including river rafting, skiing/snow boarding, and biking. Sports enthusiasts will enjoy a night out cheering our minor league baseball team the River Cats and the NBA Sacramento Kings.
Centrally located, it is an hour and a half from the mountains of Lake Tahoe or the bay of San Francisco. For the wine connoisseur, scenic Napa Valley is just a short drive away.
Links to more community information
- Metro Chamber of Commerce Opens new window
- Sacramento Valley Online Opens new window
- California State University, Sacramento Opens new window
- Sacramento City Search Opens new window
- Sacramento Bee Opens new window
For more information contact
Those interested in applying should send their CV and statement of interest to Kristin Hallmark: email@example.com.