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Utilization Management Medical Director - WellMed Medical Group

Employer
Optum
Location
Fort Sam Houston, TX
Closing date
Apr 4, 2024

View more

Profession
Physician
Specialty
Medical Management
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. 

A partner of the OptumCare network, WellMed Medical Group (WMG) is seeking a Utilization Management Medical Director to join our WellMed medical team in the San Antonio office. We are transforming healthcare nationally while providing Physician-led care locally. Start doing your life's best work with the largest care delivery organization in the world.

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. 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
  • 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


What makes an OptumCare organization different?
  • WellMed is a Medicare Advantage Plan that operates as a health system focused on Quality/Value Based Outcomes
  • Our care model limits daily volume to allow our providers the time needed to provide quality care to their patients
  • We offer clinical and leadership growth and stability second to none
  • Providers are supported to practice at the peak of their license
  • We are influencing change on a national scale while maintaining the culture and community of our local care organizations


Compensation/Benefits Highlights:
  • OptumCare Physician Partnership Plan
  • 401k with match, Executive Savings Plan with Match, and UHG Employee Stock Purchase Program
  • Comprehensive Benefits from Optum Partner Services


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
  • Active, unrestricted medical license in Texas or the ability to obtain one rapidly
  • 5+ years of clinical practice experience
  • Proficiency with Microsoft Office applications


Preferred Qualifications:
  • Board certification in Family or Internal Medicine
  • 2+ years of experience in utilization management activities
  • 2+ years of experience working in a managed care health plan environment
  • Bilingual (English/Spanish) fluency


The OptumCare Story:

At OptumCare, we've found that putting clinicians at the center of care is the best way to improve lives. Our physician-led organization is one of the most dynamic and progressive health care organizations in the world, serving over 14 million people through more than 38,000 aligned physicians and 9,000 advanced practice clinicians. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation.

Would you thrive with OptumCare?
  • Do you practice evidence-based medicine?
  • Are you seeking a practice focused on patient-centered quality care, not volume?
  • Are you a team player - comfortable delegating and empowering teams?
  • Are you constantly seeking better ways to do things?
  • Do you want to be part of something better?


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

California, Colorado, Connecticut, Hawaii, Nevada, New York, Rhode Island, or Washington Residents Only: The salary/hourly range for California, Colorado, Connecticut, Hawaii, Nevada, New York, Rhode Island, or Washington residents is $286,104 to $397,743. 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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

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

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