Full-Time Sr Medical Director – Utilization Management
Wellmark, Inc. is hiring a remote Full-Time Sr Medical Director – Utilization Management. The career level for this job opening is Senior Manager and is accepting Des Moines, IA based applicants remotely. Read complete job description before applying.
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Wellmark, Inc.
Job Title
Sr Medical Director – Utilization Management
Posted
Career Level
Full-Time
Career Level
Senior Manager
Locations Accepted
Des Moines, IA
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Job Details
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. A top candidate will be a self-directed and results-oriented physician who leads by example to serve as Wellmark's subject matter expert on effective and efficient processes to reduce overuse and improve quality for our members. Internal + external relationship and trust building is essential for success.
What you will do:
- Demonstrate ownership of overall effectiveness and efficiency of UM process and outcomes.
- Demonstrate deep expertise in delivering UM inpatient and outpatient decisions, especially on complex cases.
- Provide leadership and day-to-day management of financial and human resources.
- Responsible to perform oversight of independent review organization appeals.
- Responsible for providing exemplary engagement on peer-to-peer calls and escalated UM cases.
- Responsible for oversight of delegated specialty UM vendor clinical decision-making.
- Partners with and demonstrate effectiveness with Wellmark’s Business Analytics team to drive product development/new total cost of care (TCOC) initiatives to reduce overuse.
- Perform other initiatives and projects as required.
Required Qualifications:
- 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.
- 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.
FAQs
What is the last date for applying to the job?
The deadline to apply for Full-Time Sr Medical Director – Utilization Management at Wellmark, Inc. is
16th of October 2025
. We consider jobs older than one month to have expired.
Which countries are accepted for this remote job?
This job accepts [
Des Moines, IA
] applicants. .
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