Medical Director, Utilization Management Physician - WellMed - Remote

WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the way clinicians work and live.

The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over or under utilization of services and proactively suggesting improvements to WellMed Medical Management’s utilization management program.

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career and will empower you to live your best life at work and at home.

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
• 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
• Customer Service
  • Oversees and insures physician compliance with UM plan
  • Performs all duties in a professional and responsible manner
  • Responds to physicians and staff in a prompt, pleasant and professional manner
  • Respects physician, patient, and organizational confidentiality
  • Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met
• Personal and Physician Development
  • Strives to personally expand working knowledge of all aspects of the UM department
  • An active participant in physician meetings
  • Orients new physicians to ensure understanding of company policy and resources available for physician support
  • Assists in the growth and development of subordinates by sharing special knowledge with others and promotes continued education classes
  • Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines

Required Qualifications:

• Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S.
  • Board certification in Family Medicine or Internal Medicine
  • Active, unrestricted medical license (any state)
  • 5+ years of post-residency clinic practice experience
  • Proficiency with Microsoft Office applications

Preferred Qualifications:

• 2+ years of experience in utilization management activities
  • 2+ years of experience with acute admissions
  • 2+ years of experience working in a managed care health plan environment
  • Bilingual (English/Spanish) fluency

About Optum

Optum is the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare. We’re a global organization that’s evolving health care so everyone can have the opportunity to live their healthiest life. With our hands across all aspects of health, we'll provide you with a rewarding career that enables you to grow in the directions that best fit your passions. This is your opportunity to be part of a team that’s dedicated to Caring. Connecting. Growing together.