Addressing Medical Director Turnover & Recruiting Costs in Prior Authorization Reviews

Initial Challenge

A leading health plan faced significant challenges in recruiting, training, and retaining full-time medical directors experienced in utilization management (UM) for prior authorization (PA) and concurrent reviews. The difficulty in finding and retaining qualified physicians for these roles can make it challenging to maintain a stable and effective review process. The cost of recruiting and onboarding a new medical director, which can reach up to $60,000, further compounded the issue. The health plan needed a more efficient and cost-effective solution to manage their PA and concurrent case reviews, particularly as they aimed to expand the scope of their UM program to include a new prior authorization policy.