Remote Medical Director, Utilization & Policy

WellSense Health Plan; Boston (MA); Remote; USD 173,000 - 250,000; Full time

Benefits offered by this job

Competitive salaries

Excellent benefits

Flexible Spending Accounts

403(b) savings matches

Job summary

WellSense Health Plan in Boston seeks a Medical Director to oversee clinical activities and support quality management initiatives. The ideal candidate will have over 8 years of experience, including extensive clinical and medical management expertise. Responsibilities include conducting reviews of medical necessity and participating in clinical committees.

This role offers a full-time remote work opportunity with a competitive salary range of $173,000 - $250,000. WellSense prioritizes member-centered care and values diversity and inclusion.

Qualifications

• 8-10+ years of related experience, including 5 years direct clinical experience.
• 3 years experience in medical management in a managed care setting.
• Preference for Board Certification in Internal Medicine or related specialties.

Responsibilities

• Oversee clinical case review and utilization management activities.
• Conduct reviews of prior authorizations and grievances.
• Support department quality improvement and utilization management goals.

Skills

Clinical skills

Communication skills

Knowledge of managed care principles

Leadership skills

Education

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)

Job description

WellSense Health Plan in Boston seeks a Medical Director to oversee clinical activities and support quality management initiatives. The ideal candidate will have over 8 years of experience, including extensive clinical and medical management expertise. Responsibilities include conducting reviews of medical necessity and participating in clinical committees.

This role offers a full-time remote work opportunity with a competitive salary range of $173,000 - $250,000. WellSense prioritizes member-centered care and values diversity and inclusion.