Market Medical Director, Utilization Management - WellMed - Remote

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

Primary Responsibilities:

• Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values
• Educates primary care physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance related to market activities
• Develops strategies for improving all aspects of market performance including RAPS, membership, and medical management
• Participates in case review and medical necessity determination
• Conducts post service reviews issued for medical necessity and benefits determination coding
• Analyzes aggregate data and reports to primary care physician
• Serves as the liaison between physicians and health plan Medical Directors
• Supervises the functions of Care Coordination
• Assesses the effectiveness of the specialty network to ensure members have access to multi-specialties within their demographic area
• Represents the providers as an influence to the credentialing committee
• Reviews policies and procedures of credentialing department and offers guidance for revision and implementation of process
• Educates primary care network and assists in problem resolution
• Assists in development of medical management protocols
• Performs analysis of utilization data and suggests/implements corrective action plans with network physicians
• Performs all other related duties as assigned

Required Qualifications:

• Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree
• Board Certified Family Practitioner or Internal Medical Specialist
• Unrestricted licensed in Texas, Florida, Georgia, or New Jersey
• 5+ years of clinical practice experience
• 2+ years of experience in utilization management activities
• Proficiency with Microsoft Office applications

Preferred Qualifications:

• Unrestricted license in New Mexico
• 2+ years of experience with acute admission experience
• 2+ years of experience working in a managed care health plan environment
• Bilingual (English/Spanish) fluency

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $286,104 to $397,743 annually. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.