Medical Director, Utilization Management Physician - WellMed - Remote

Lensa; Jacksonville (FL); Remote; USD 238,000 - 358,000; Full time

Job summary

An established industry player is seeking a Medical Director for Utilization Management. This pivotal role involves ensuring efficient management of healthcare services, enhancing patient care, and leading a team in a collaborative environment. The ideal candidate will have extensive clinical experience and a passion for improving healthcare delivery. Join a forward-thinking organization that values diversity and innovation, offering you the chance to make a significant impact in the health sector while enjoying flexible remote work options.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Qualifications

• 5+ years of post-residency clinic practice experience.
• Proficiency in compliance regulations for CMS and health plans.

Responsibilities

• Develop and maintain an efficient Utilization Management program.
• Conduct post-service reviews for medical necessity and benefits determination.

Skills

Utilization Management

Clinical Practice

Patient Care

Microsoft Office

Bilingual (English/Spanish)

Education

Doctor of Medicine (M.D.)

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 commensurate 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 both 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 in a professional and responsible manner
• Responds to physicians and staff in a prompt, pleasant and professional manner
• Respects physician, patient, and organizational confidentiality
• Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met
  
  

Personal and Physician Development

• Strives to personally expand working knowledge of all aspects of the UM department
• An active participant in physician meetings
• Orients new physicians to ensure understanding of company policy and resources available for physician support
• Assists in the growth and development of subordinates by sharing special knowledge with others and promotes continued education classes
• Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines
  
  

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

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
• An active, unrestricted medical license (any state)
• 5+ years of post-residency clinic practice experience
• Proficiency with Microsoft Office applications
  
  

Preferred Qualifications

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

The salary range for this role is $ $238,000 to $ $357,500 per year. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

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