Remote Medical Director, Utilization Management

St. Cloud Orthopedics; San Antonio, Northern (TX, KY); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Benefits package

Incentive programs

Equity stock purchase

401k contribution

Job summary

WellMed, part of Optum, seeks an experienced physician to join the Utilization Management team as Medical Director. This remote role supports WellMed Medical Management, Inc. with UM determinations and program improvements, aiming to optimize care for seniors nationwide.

You’ll join a clinician-led organization that values collaboration, diversity, and the Quadruple Aim while enjoying the flexibility to work remotely from anywhere in the U.S.

Qualifications

• Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S.

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
• Oversees and ensures physician compliance with UM plan
• Responds to physicians and staff in a prompt, pleasant and professional manner
• Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines

Skills

Microsoft Office

5+ years clinical experience

Education

MD/DO/MBBS

Job description

WellMed, part of Optum, seeks an experienced physician to join the Utilization Management team as Medical Director. This remote role supports WellMed Medical Management, Inc. with UM determinations and program improvements, aiming to optimize care for seniors nationwide.

You’ll join a clinician-led organization that values collaboration, diversity, and the Quadruple Aim while enjoying the flexibility to work remotely from anywhere in the U.S.