Medical Director, MA License
Concert Health
Cloud
Senior Medical Director – Utilization Management
Wellmark Blue Cross and Blue Shield
full-time
Posted on:
Location Type: Remote
Location: Remote • Iowa • 🇺🇸 United States
Visit company websiteJob Level
Senior
About the role
- As Senior Medical Director for Utilization Management (UM), you will be an effective change leader and help develop and guide the strategic direction for Utilization Management initiatives at Wellmark.
- You will directly impact the success, growth, and development of team members by setting clear expectations, coaching to each team member’s strengths, and fostering a team-centric work environment.
- You will strategically collaborate with the Health Services team and across the organization to develop and maintain accountability for initiatives to reduce overuse with results that are validated by Wellmark’s analytical team and are grounded in evidence-based care.
- You will perform oversight of independent review organization appeals and ensure effectiveness of end-to-end process for medical appeals.
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.
- Masterful at delivering timely UM decisions based on evidence, cogent clinical reasoning, benefit information, applicable policies, and other relevant information.
- Demonstrated formal or informal leadership experience.
- Strong interpersonal skills are mandatory, including clear and concise written and verbal communication.
- Proven ability to set clear goals/expectations and motivates teams to achieve success with an eye toward promoting a culture of collegiality and excellence.
- Demonstrated sense of ownership, drive and initiative to continuously improve outcomes.
- General understanding of medical policy development.
- Demonstrated domain knowledge for interpretation and application of data and analysis at the highest level and broadest scope.
- Proficiency with Microsoft Office applications – e.g., Word, Outlook.
Benefits
- Unique benefit offerings
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
Utilization Managementevidence-based careclinical reasoningmedical policy developmentdata interpretationdata analysis
Soft skills
leadershipinterpersonal skillswritten communicationverbal communicationgoal settingteam motivationownershipinitiativecontinuous improvement
Certifications
M.D.D.O.Board Certification
