Full-Time Medical Director – Inpatient Utilization Management

As an experienced M.D. or D.O. in adult acute care setting(s), you will use evidence-based decision making to perform inpatient case reviews that are timely and clinically appropriate. You will concisely synthesize clinical information to document a clear summary of a medically necessary determination. While case reviews are this role's primary priority, you will have the opportunity to make recommendations on efficiencies and innovations. You will partner across the organization with other internal teams.

You are decisive and have a strong ability to influence internally and externally. Critical thinking, sound judgment, and decisiveness are key. You are collaborative by nature and are energized by the opportunity to work in a highly integrated and matrixed culture. Managed care experience in a large commercial organization is a plus.

Iowa or South Dakota-based candidates preferred but open to remote for the right candidate. This full-time position will also work a rotating on-call schedule for weekend and holiday reviews.

• Graduate of an accredited medical school; M.D. or D.O. degree is required.
• Active and unrestricted license to practice medicine in Iowa or Iowa Administrative Medical License is required within 3 months from date of hire AND must be licensed in the state in which you reside.
• Current Board Certification in Emergency Medicine, Family Medicine, or Internal Medicine.
• 3-5 years of adult inpatient clinical experience in an acute care hospital setting.
• Ability to participate in rotating on call schedule for weekends and holiday reviews.
• Strong analytical and critical thinking skills.
• Demonstrated commitment to service excellence and advocacy for member care.
• Strong consulting and interpersonal skills.
• Excellent verbal and written communication skills.
• Strong change management skills.
• Ability to mentor and guide others and work within the teams.
• Self-starter with strong organization and time management skills.
• Strong technical acumen.

• Previous administrative medical experience.

1. Demonstrate ability to apply clinical experience to render medical necessity determinations for adult acute inpatient care.
2. Concisely synthesize clinical information to document a clear summary for the basis of medical necessity determinations.
3. Develop an effective and collaborative relationship with Wellmark’s UM leaders.
4. Defend UM decisions internally and externally.
5. Demonstrate sound judgment by seeking consultation from leader on complex UM case reviews.
6. Effectively engage in peer-to-peer calls.
7. Perform overflow Outpatient reviews as needed.
8. Deep knowledge of Wellmark’s medical policies.
9. Participate in rotating on call schedule for weekend and holiday reviews.
10. Other duties as assigned.

This job requires a non-compete agreement.

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