Medical Director, Utilization Management Physician - WellMed - Remote

WellMed, part of the Optum family of businesses, is seeking a Medical Director, Utilization Management Physician to join our team anywhere within the U.S. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.

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. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

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.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

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

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
• An 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.