Medical Director, Utilization Management Physician - WellMed - Remote

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

Job summary

A leading healthcare organization is seeking a Medical Director for Utilization Management to join their team. The role involves overseeing utilization management determinations, ensuring compliance, and supporting physician development. Candidates should possess an M.D. or D.O. with board certification and extensive clinical experience.

Benefits

Comprehensive benefits packages

Incentives and stock purchase options

401k plans

Qualifications

• 5+ years of post-residency clinical practice experience.
• Active, unrestricted medical license (any state).

Responsibilities

• Support utilization management determinations and identify utilization trends.
• Conduct post service reviews for medical necessity and benefits determination.
• Assist in the development of medical management and utilization management protocols.

Skills

Proficiency with Microsoft Office applications

Education

Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.)

Board certification in Family Medicine or Internal Medicine

Job description

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Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over or under utilization of services and proactively suggesting improvements to WellMed Medical Management’s utilization management program.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Position Highlights & Primary Responsibilities

• Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and in line with company values
• Remain current and proficient in CMS criteria hierarchy and organizational determination processes
• Participates in case review and medical necessity determination
• Maintain proficiency in compliance regulations for CMS and delegated health plans
• Conducts post service reviews issued for medical necessity and benefits determination coding
• Assists in development of medical management, care management, and utilization management protocols
• Performs all other related duties as assigned.

Customer Service

• Oversees and ensures physician compliance with UM plan
• Performs all duties professionally and responsibly
• Responds promptly, pleasantly, and professionally to physicians and staff
• Respects physician, patient, and organizational confidentiality
• Provides quality assurance and education on current medical technologies, review criteria, accepted practice guidelines, and UM policies and procedures, with counsel when criteria are not met

Personal and Physician Development

• Strives to expand knowledge of all aspects of the UM department
• Participates actively in physician meetings
• Orients new physicians regarding company policy and available resources
• Supports the growth and development of subordinates by sharing knowledge and promoting continued education
• Attends continuing education to stay updated on medical advancements and practice guidelines

In 2011, WellMed partnered with Optum to provide care across Texas and Florida. WellMed is a network of doctors, specialists, and other professionals caring for over 1 million older adults with over 16,000 doctors’ offices. Our focus is on preventative health care, aiming to change health care for seniors. WellMed has more than 22,000 healthcare providers caring for over 900,000 older adults. We’re committed to improving healthcare for everyone.

You’ll be rewarded and recognized for your performance in an environment that challenges you and provides clear success criteria and development opportunities.

Required Qualifications

• Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S.
• Board certification in Family Medicine or Internal Medicine
• Active, unrestricted medical license (any state)
• 5+ years of post-residency clinical practice experience
• Proficiency with Microsoft Office applications

Preferred Qualifications

• 2+ years of utilization management experience
• 2+ years of experience with acute admissions
• 2+ years in a managed care health plan environment
• Bilingual (English/Spanish) fluency

The salary range is $238,000 to $357,500 annually, based on experience and achievement. Benefits include comprehensive packages, incentives, stock purchase, and 401k. All employees must adhere to UnitedHealth Group’s policies, including telecommuting and drug testing requirements.