Remote Medical Director — Utilization Management

Tnafp; San Antonio, Northern (TX, KY); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits package

Remote work option

Job summary

WellMed, part of the Optum family, seeks a Medical Director for Utilization Management to support WellMed Medical Management, Inc. by making UM determinations, identifying utilization trends, and proposing program improvements. This role offers remote work from anywhere in the U.S.

and integration with Optum’s resources and network. Responsibilities include developing the UM program, CMS criteria mastery, case reviews, and compliance with CMS and delegated plans.

Qualifications

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

Responsibilities

• Develop and maintain an efficient utilization management program.
• Stay current with CMS criteria hierarchy and determination processes.
• Participate in case reviews and medical necessity determinations.
• Ensure compliance with CMS and delegated health plan regulations.
• Assist in growth of medical management, care management, and UM protocols.
• Attend physician meetings and orient new physicians.

Skills

MS Office proficiency

Active medical license

Licensing knowledge

Education

MD/DO/MBBS

Job description

WellMed, part of the Optum family, seeks a Medical Director for Utilization Management to support WellMed Medical Management, Inc. by making UM determinations, identifying utilization trends, and proposing program improvements. This role offers remote work from anywhere in the U.S.

and integration with Optum’s resources and network. Responsibilities include developing the UM program, CMS criteria mastery, case reviews, and compliance with CMS and delegated plans.