Physician Supervisor, Utilization Management

divh2Physician Supervisor, Utilization Management/h2pWere building a world of health around every individual shaping a more connected, convenient and compassionate health experience. At CVS Health, youll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger helping to simplify health care one person, one family and one community at a time./ppThe Physician Supervisor, Utilization Management is responsible for overseeing the day to day utilization management (UM) processes to ensure the delivery of high-quality, cost-effective healthcare services. This role involves managing the review of medical necessity, appropriateness of care, and the coordination of healthcare services. The Physician Supervisor will lead and manage a team of UM physicians, providing guidance, support, and professional development opportunities to optimize team performance./ppCore Responsibilities:/ppLeadership and Management:/pulliLead and manage the Utilization Management team, providing guidance, training, and support to the day to day issues./liliSupport recruiting, hiring, and retaining skilled UM clinical staff, fostering a collaborative and high-performance work environment alongside Manager, Utilization Management/liliConduct regular performance evaluations, offering feedback, coaching, and professional development opportunities./liliMonitor and evaluate the performance of the UM team, ensuring efficiency and effectiveness in all UM activities./li/ulpUtilization Review:/pulliConduct and oversee clinical reviews of medical records to determine the medical necessity and appropriateness of healthcare services./liliEnsure timely and accurate review of prior authorizations, concurrent reviews, and retrospective reviews./liliCollaborate with healthcare providers to facilitate appropriate utilization of healthcare resources./li/ulpCompliance and Regulation:/pulliEnsure compliance with all federal, state, and local regulations related to utilization management./liliStay current with changes in healthcare regulations and standards affecting UM practices./li/ulpCollaboration and Communication:/pulliWork closely with other departments, including Transitions, Case Management, and Care Teams, to ensure coordinated and integrated care./liliServe as a clinical resource and advisor to the UM team and other departments./liliOther duties as assigned./li/ulpWhat are we looking for?/ppAn ideal candidate will satisfy the following:/pulliAt least 2 years experience providing Utilization Management services to a Medicare and/or Medicaid line of business/liliExcellent verbal and written communication skills/liliA current, clinical, unrestricted license to practice medicine in the United States. (NCQA Standard)/liliPrior clinical leadership or supervision experience is preferred./liliGraduate of an accredited medical school. M.D. or D.O. Degree is required. (NCQA Standard)/lili3-5 years of clinical practice in a primary care setting/liliDeep understanding of managed care, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, and pharmacy management/liliStrong record of continuing education activities (relevant to practice area and needed to maintain licensure)/liliDemonstrated understanding of culturally responsive care/liliProven organizational and detail-orientation skills/liliAbility to collaborate effectively with a staff, providers, and a diverse group of leaders./liliUS work authorization/liliSomeone who embodies being Oaky/li/ulpWhat does being Oaky look like?/pulliRadiating positive energy/liliAssuming good intentions/liliCreating an unmatched patient experience/liliDriving clinical excellence/liliTaking ownership and delivering results/liliBeing relentlessly determined/li/ulpWhy Oak Street Health?/ppOak Street Health is on a mission to Rebuild healthcare as it should be, providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patients communities, and focused on the quality of care over volume of services. Were an organization on the move! With over 150 locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oaky values and passion for our mission./ppOak Street Health Benefits:/pulliMission-focused career impacting change and measurably improving health outcomes for medicare patients/liliPaid vacation, sick time, and investment/retirement 401K match options/liliHealth insurance, vision, and dental benefits/liliOpportunities for leadership development and continuing education stipends/liliNew centers and flexible work environments/liliOpportunities for high levels of responsibility and rapid advancement/li/ulpOak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply./ppPay Range/ppThe typical pay range for this role is:/pp$174,070.00 - $374,920.00/ppThis pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the companys equity award program./ppOur people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong./ppGreat benefits for great people/ppWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families./ppThis full?time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well?being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility./ppAdditional details about available benefits are provided during the application process and on Benefits Moments./ppWe anticipate the application window for this opening will close on: 05/11/2027/ppQualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws./p/div