Remote Medical Director, Utilization Management

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

Benefits offered by this job

Remote work

Job summary

WellMed, part of the Optum family, is seeking an experienced physician to join the Utilization Management team. The Medical Director for Utilization Management will support WellMed Medical Management by making UM determinations and suggesting program improvements.

This remote-friendly role offers the chance to influence care on a national scale within a clinician-led organization that values collaboration and continuous learning.

Qualifications

• MD/DO/MBBS 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

• Develop and maintain an efficient UM program aligned with health plan needs and company values.
• Stay current with CMS criteria hierarchy and organizational determination processes.
• Participate in case reviews and medical necessity determinations.
• Maintain compliance with CMS and delegated health plans regulations.
• Conduct post-service reviews for medical necessity and benefits determination coding.
• Assist in developing medical management, care management, and utilization management protocols.
• Perform other related duties as assigned.

Skills

Interdisciplinary collaboration

Policy compliance

Education

MD/DO/MBBS

Tools

Microsoft Office

Job description

WellMed, part of the Optum family, is seeking an experienced physician to join the Utilization Management team. The Medical Director for Utilization Management will support WellMed Medical Management by making UM determinations and suggesting program improvements.

This remote-friendly role offers the chance to influence care on a national scale within a clinician-led organization that values collaboration and continuous learning.