Medical Director for Utilization Management

Join WellMed's Utilization Management Team!

WellMed, part of the Optum family, is on the lookout for an internal medicine or family medicine physician to enhance our Utilization Management team. At Optum, we are committed to transforming healthcare for clinicians and creating an improved experience for patients.

As a Medical Director in our Utilization Management team, you will play a vital role in shaping our healthcare approach, supported by exceptional clinical resources and data. Our collaborative work environment values diversity and inclusion, aligning with our goals to enhance the Quadruple Aim. You'll have the opportunity to innovate and strive to improve care for millions of patients across the country.

Your Responsibilities

• Develop and maintain an effective Utilization Management program that aligns with our health plan members' needs and our company's values.
• Stay updated on CMS criteria and organizational determination processes.
• Engage in case reviews and medical necessity determinations.
• Ensure compliance with CMS and delegated health plans' regulations.
• Conduct post-service reviews related to medical necessity and benefits determination coding.
• Assist in creating protocols for medical management, care management, and utilization management.
• Perform additional related duties as assigned.

Customer Service Excellence

• Ensure physician adherence to the Utilization Management plan.
• Conduct all duties professionally and responsively.
• Respond promptly to colleagues and staff in a courteous and professional manner.
• Safeguard confidentiality of physicians, patients, and the organization.
• Provide quality assurance and educate on current medical technologies, review criteria, and UM policies.

Personal and Professional Development

• Seek to enhance your knowledge of all aspects of the Utilization Management department.
• Actively participate in physician meetings.
• Guide new physicians in understanding company policies and available support resources.
• Encourage the growth and learning of your team by sharing knowledge and promoting educational opportunities.
• Attend continuing education to stay informed on medical advancements and innovative practice guidelines.

Since our partnership with Optum in 2011, WellMed has specialized in providing care to over 1 million older adults across Texas and Florida, focusing on preventative health care.

You'll be recognized for your performance in a challenging environment that provides clear direction for success and opportunities for growth in your career.

Key Qualifications

• Medical Doctor (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 (in any state).
• A minimum of 5 years post-residency experience in clinical practice.
• Proficient in Microsoft Office.

Preferred Qualifications

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

Please note that all remote employees must adhere to UnitedHealth Group's Telecommuter Policy.

Salary: The salary for this role ranges from $269,500 to $425,500 annually based on full-time employment, factoring in local labor markets, experience, and qualifications. We offer a comprehensive benefits package, including an equity stock purchase plan and 401k contributions, all subject to eligibility requirements.

Application Deadline: This position will be open for a minimum of 2 business days or until we gather an adequate candidate pool. Early closure may occur due to high application volume.

OptumCare is an Equal Employment Opportunity employer. We welcome applicants regardless of race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or veteran status.

OptumCare operates a drug-free workplace; candidates will need to pass a drug test as part of the hiring process.