Remote Medical Director, Utilization Management

The Mississippi Bar; San Antonio (TX); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Remote work from anywhere in the U.S.

Job summary

WellMed Medical Management, Inc. is seeking a Medical Director for Utilization Management to support the UM program and optimize medical necessity determinations across plans.

You'll work remotely from anywhere in the United States, require an MD/DO/MBBS with board certification in Family or Internal Medicine, an active unrestricted license, and 5+ years of post-residency clinic experience, collaborating with CMS criteria and care-management protocols.

Qualifications

• MD/DO/MBBS required and board-certified in Family Medicine, Internal Medicine, or Emergency Medicine.
• Active, unrestricted medical license in any state.
• 5+ years of post-residency clinic practice experience.
• Proficiency with Microsoft Office applications.

Responsibilities

• Assists in development and maintaining an efficient UM program.
• Remain current with CMS criteria hierarchy and determination processes.
• Participates in case review and medical necessity determination.
• Maintains proficiency in compliance regulations for CMS and delegated health plans.
• Conducts post-service reviews for medical necessity and benefits determination coding.
• Assists in development of medical management, care management, and UM protocols.
• Performs other related duties as assigned.

Skills

MS Office proficiency

Clinical experience

Education

MD/DO/MBBS

Board certification in Family/Internal/Emergency Medicine

Unrestricted medical license

Job description

WellMed Medical Management, Inc. is seeking a Medical Director for Utilization Management to support the UM program and optimize medical necessity determinations across plans.

You'll work remotely from anywhere in the United States, require an MD/DO/MBBS with board certification in Family or Internal Medicine, an active unrestricted license, and 5+ years of post-residency clinic experience, collaborating with CMS criteria and care-management protocols.