Remote Medical Director, Utilization Management

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

Benefits offered by this job

Benefits package

Job summary

WellMed Medical Management, Inc. seeks an Internal Medicine/Family Medicine physician to join our Utilization Management team as Medical Director. You will make UM determinations, monitor CMS criteria, and help shape medical necessity decisions within a managed care framework.

Join Optum and contribute to improving care for a large Texas patient population while collaborating with a multidisciplinary team committed to high-quality, cost-effective care and continuous professional growth.

Qualifications

• MD/DO/MBBS degree 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

MS Office

Bilingual English/Spanish

Education

MD/DO/MBBS

Board certification in Family/Internal/Emergency Medicine

Job description

WellMed Medical Management, Inc. seeks an Internal Medicine/Family Medicine physician to join our Utilization Management team as Medical Director. You will make UM determinations, monitor CMS criteria, and help shape medical necessity decisions within a managed care framework.

Join Optum and contribute to improving care for a large Texas patient population while collaborating with a multidisciplinary team committed to high-quality, cost-effective care and continuous professional growth.