Medical Director, Utilization Management Physician - WellMed - Remote

Lensa; Austin (TX); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading healthcare organization is seeking a Medical Director for Utilization Management. This role involves making utilization management determinations, analyzing trends, and ensuring compliance with regulations. The position offers remote work flexibility within the U.S. Ideal candidates will have a medical degree, board certification, and extensive clinical experience.

Benefits

Comprehensive benefits package

Incentives

Stock purchase

401k

Qualifications

• 5+ years post-residency clinical practice required.
• 2+ years in utilization management preferred.

Responsibilities

• Develop and maintain an efficient utilization management program.
• Ensure compliance with CMS and delegated health plan regulations.
• Conduct post-service reviews for medical necessity.

Skills

Proficiency with Microsoft Office

Bilingual in English/Spanish

Education

MD, DO, or M.B.B.S.

Board certification in Family or Internal Medicine

Job description

Job Description: Medical Director, Utilization Management

WellMed, part of the Optum family, is seeking a Medical Director for Utilization Management to join our team. This role supports WellMed Medical Management by making utilization management determinations, analyzing utilization trends, and suggesting improvements to the program.

The position offers the flexibility to work remotely from anywhere within the U.S.

Position Highlights & Primary Responsibilities

• Develop and maintain an efficient utilization management program aligned with company values.
• Stay current with CMS criteria hierarchy and organizational determination processes.
• Participate in case reviews and medical necessity determinations.
• Ensure compliance with CMS and delegated health plan regulations.
• Conduct post-service reviews for medical necessity and coding benefits.
• Assist in developing medical management protocols.
• Perform other related duties as assigned.

Customer Service Responsibilities

• Ensure physician compliance with UM plans.
• Respond professionally to physicians and staff.
• Maintain confidentiality of physicians, patients, and organization.
• Provide education on medical technologies, review criteria, and policies.

Personal and Physician Development

• Expand knowledge of UM department aspects.
• Participate in physician meetings and orient new physicians.
• Support the growth of subordinates and promote continued education.
• Attend continuing education to stay updated on medical advancements.

Qualifications

Required:

• MD, DO, or M.B.B.S.
• Board certification in Family or Internal Medicine.
• Active, unrestricted medical license.
• 5+ years post-residency clinical practice.
• Proficiency with Microsoft Office.

Preferred:

• 2+ years in utilization management.
• Experience with acute admissions and managed care.
• Bilingual in English/Spanish.

Compensation

The salary range is $238,000 to $357,500 annually, based on experience and achievement. Benefits include comprehensive packages, incentives, stock purchase, and 401k.

Application Details

This posting remains for at least 2 business days or until enough candidates are received. Remote employees must adhere to telecommuting policies.

OptumCare is an Equal Opportunity Employer and a drug-free workplace, requiring drug testing prior to employment.