Wellmark Blue Cross and Blue Shield

Medical Director

• Eligible to work remotely from home with required travel to Des Moines, Iowa during onboarding and quarterly thereafter.
• Develop and guide strategic direction for Utilization Management initiatives at Wellmark.
• Lead and manage team members, set clear expectations, coach, foster team-centric work environment.
• Serve as subject matter expert on effective and efficient processes to reduce overuse and improve quality for members.
• Collaborate with Health Services and across organization to develop and maintain accountability for initiatives to reduce overuse.
• Perform UM and appeals case reviews and provide oversight of independent review organization appeals.
• Provide leadership and day-to-day management of financial and human resources for UM team.
• Train and mentor physician team and facilitate ongoing team-based learning.
• Engage on peer-to-peer calls and escalated UM cases and consult with stakeholders.
• Oversee delegated specialty UM vendor clinical decision-making and audit UM decisions.
• Partner with Business Analytics to drive product development/new TCOC initiatives to reduce overuse.
• Perform other initiatives and projects as required.

Senior Medical Director – Utilization Management