Medical Director, Utilization Management Physician - WellMed - Remote

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

Job summary

A leading healthcare organization is seeking a Medical Director for Utilization Management to enhance the efficiency of their UM program. The role involves making determinations, identifying trends, and ensuring compliance with regulations. The ideal candidate will have significant clinical experience and a strong medical background, with opportunities for remote work flexibility.

Benefits

Comprehensive benefits packages

Incentive programs

Stock purchase

401k

Qualifications

• 5+ years of post-residency clinic practice experience.
• Active, unrestricted medical license.

Responsibilities

• Assist in developing and maintaining an efficient UM program.
• Conduct post-service reviews for medical necessity and benefits determination.

Skills

Bilingual in English/Spanish

Education

Doctor of Medicine (M.D.)

Doctor of Osteopathy (D.O.)

M.B.B.S.

Tools

Microsoft Office

Job description

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.

Position Overview

The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends, and proactively suggesting improvements to the program.

Responsibilities

1. Assist in developing and maintaining an efficient UM program.
2. Remain current with CMS criteria hierarchy and determination processes.
3. Participate in case review and medical necessity determinations.
4. Maintain proficiency in compliance regulations.
5. Conduct post-service reviews for medical necessity and benefits determination.
6. Assist in developing medical management protocols.
7. Perform other related duties as assigned.

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.
• 5+ years of post-residency clinic practice experience.
• Proficiency with Microsoft Office.

Preferred Qualifications

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

Additional Details

Salary range: $238,000 - $357,500 per year, based on experience and achievement. Benefits include comprehensive packages, incentive programs, stock purchase, and 401k. This role offers remote work flexibility within the U.S.