Remote Medical Director, Utilization Management

RXinsider LTD.; San Antonio (TX); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentives programs

Equity stock plan

401k

Job summary

WellMed, part of the Optum family, is seeking an Internal Medicine or Family Medicine physician to join the Utilization Management team. The Medical Director will support WellMed Medical Management by making UM determinations and identifying utilization trends to improve the program.

Remote work is available from anywhere in the U.S. The role offers a comprehensive benefits package and the chance to contribute to a large, nationwide health system focused on improving care for seniors.

Qualifications

• MD, DO, or MBBS is required.
• Board certification in Family Medicine, Internal Medicine, or Emergency Medicine.
• Active, unrestricted medical license (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 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.

Skills

Board certification

Medical license

MS Office proficiency

Education

MD/DO/MBBS

Tools

Microsoft Office

Job description

WellMed, part of the Optum family, is seeking an Internal Medicine or Family Medicine physician to join the Utilization Management team. The Medical Director will support WellMed Medical Management by making UM determinations and identifying utilization trends to improve the program.

Remote work is available from anywhere in the U.S. The role offers a comprehensive benefits package and the chance to contribute to a large, nationwide health system focused on improving care for seniors.