Medical Director - Disability Evaluation Services (Remote)
SoundCloud
Senior Medical Director – Utilization Management
Wellmark Blue Cross and Blue Shield
full-time
Posted on:
Origin: • 🇺🇸 United States • Iowa
Visit company websiteJob Level
Senior
About the role
- 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.
Requirements
- M.D. or D.O. degree.
- Active and unrestricted license to practice medicine in Iowa and/or South Dakota is required within 3 months from date of hire OR an administrative license; must be licensed in the state in which you reside.
- Current Board Certification approved by the American Board of Medical Specialties or American Osteopathic Association.
- 3-5 years of Utilization Management experience in Commercial programs at a large and complex managed care organization.
- A track record of accomplishment as a clinical leader demonstrating increasing responsibilities and expertise is essential.
- Demonstrated formal or informal leadership experience.
- Proficiency with Microsoft Office applications – e.g., Word, Outlook.
- Must be licensed in the state in which you reside.
- At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States.
