Medical Director, Utilization Management Physician - WellMed - Remote - 2281980

Primary Care Plus; San Antonio (TX); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading healthcare organization is seeking a Medical Director for Utilization Management. This remote role involves overseeing utilization decisions, ensuring compliance, and enhancing community health. Candidates should have a strong clinical background and experience in utilization management. Join a supportive team focused on improving healthcare delivery and work-life balance.

Benefits

Comprehensive benefits package

Incentives

Stock purchase

401k

Qualifications

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

Responsibilities

• Develop and maintain an efficient UM program.
• Ensure compliance with CMS regulations.
• Conduct post-service reviews for medical necessity.

Skills

Bilingual

Proficiency with Microsoft Office

Education

MD

DO

MBBS

Board certification in Family or Internal Medicine

Job description

Join to apply for the Medical Director, Utilization Management Physician - WellMed - Remote - 2281980 role at Primary Care Plus.

WellMed, part of the Optum family, seeks an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization focused on improving healthcare delivery.

As part of the Optum Care Delivery team, you'll contribute to our mission to enhance healthcare for everyone. We provide clinical resources, data, and support to help you serve your patients better. Work alongside talented peers in a diverse and inclusive environment, aiming for the Quadruple Aim. We support your career growth and work-life balance, empowering you to make a difference in community health and innovate in practice.

The Medical Director for Utilization Management will support WellMed Medical Management by making utilization decisions, analyzing trends, and suggesting improvements to the UM program. This role offers remote work flexibility within the U.S.

Position Highlights & Responsibilities

• Develop and maintain an efficient UM program aligned with company values
• Stay current with CMS criteria and 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 benefits coding
• Assist in developing medical, care, and utilization management protocols
• Perform other related duties as assigned

Customer Service

• Ensure physician compliance with UM plan
• Respond promptly and professionally to physicians and staff
• Maintain confidentiality and provide education on medical technologies and policies

Personal and Physician Development

• Expand knowledge of UM department aspects
• Participate actively in physician meetings
• Orient new physicians on policies and resources
• Support the growth of team members and ongoing education

Qualifications

Required:

• MD, DO, or MBBS
• Board certification in Family or Internal Medicine
• Active, unrestricted medical license (any state)
• 5+ years post-residency clinical experience
• Proficiency with Microsoft Office

Preferred:

• 2+ years in utilization management
• Experience with acute admissions
• Experience in managed care settings
• Bilingual (English/Spanish)

The salary range is $238,000 to $357,500 annually, based on experience and metrics. Benefits include comprehensive packages, incentives, stock purchase, and 401k. The application deadline is at least 2 days post posting or earlier if filled.

All remote employees must adhere to company policies. OptumCare is an Equal Opportunity Employer and a drug-free workplace, requiring a drug test prior to employment.