Concerto delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. For over a decade, we have provided extraordinary outcomes for thousands of people in these underserved groups.
The Concerto name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. It’s about the harmony of a patient’s care, health, and dignity.
Concerto Healthcare is looking for a Utilization Management Medical Director to partner with the UM clinical operations team. The UM Medical Director oversees daily utilization management and directs the medical care of our members on behalf of our clients and serves in a supporting role as medical manager and policy advisor to the company and our clients. The UM Medical Director is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with Market Medical directors and other functions that interface with medical management such as provider relations, member services, benefits and claims management. Assists (as determined by Managing Director of UM in coordination with SVP, Clinical Delivery & Operations) in short and long range program planning, total quality management (quality improvement) and external relationships. Works with Clinical Delivery and Operations leadership to support, and provide assistance and direction in overall medical management effectiveness. Monitors all issues of clinical quality management as it related to UM functions and operates within in the confines of the quality oversight policies and procedures. Collaborates with Concerto Healthcare Market Medical directors around evidence-based practices and medical policies and carries out Concerto Healthcare medical policies.
Population health – collaborative care management leadership
Physician and provider relationship management
Quality of care and service delivery