Market Medical Director, Utilization Management - WellMed - Remote at Optum

WellMed, part of the Optum family of businesses, is seeking a Market Medical Director, Utilization Management to join our team in Dallas, Austin, San Antonio, El Paso, Tampa, Orlando, Miami, Atlanta, or Savannah. 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 Market 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.  The position will also provide appropriate mentoring and leadership to physicians in the market as well as develop relationships to support growth and fiscal responsibility

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
• 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

Customer Service:

• Oversees and insures physician compliance with UM plan
• Evaluates performance of physicians in regards to established goals and objectives of the company
• Performs all duties with physicians and medical group staff in a professional and responsible manner
• Responds to physicians in a prompt, pleasant and professional manner
• Respects physician, patient, and organizational confidentiality
• Educates medical groups regarding UM policies, procedures and government-mandated regulations
• 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
• Encourages teamwork and cooperation with medical group staffs in order to prepare for cross training and float positions
• 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

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

Required Qualifications: 

• Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S. 
• Board Certified in Family Medicine or Internal Medical 
• Unrestricted licensed in Texas or Florida 
• 5+ years of post-residency clinical practice experience 
• Proficiency with Microsoft Office applications 

Preferred Qualifications

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

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents Only: The salary range for this role is $286,104 to $397,743 per year. 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 local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.