Full-Time Sr Medical Director – Utilization Management

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.

About you: You believe health care can be better and are passionate about finding ways to influence this important work. You are proactive, analytical, innovative, and partner effectively with internal and external stakeholders.

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.

What you will do:

1. Demonstrate ownership of overall effectiveness and efficiency of UM process and outcomes.
2. Demonstrate deep expertise in delivering UM inpatient and outpatient decisions, especially on complex cases.
3. Provide leadership and day-to-day management of financial and human resources.
4. Responsible to perform oversight of independent review organization appeals and ensure effectiveness of end-to-end process for medical appeals.
5. Effectively engage with external physicians, health care facility UM leadership, and other stakeholders to improve the efficiency and effectiveness of Wellmark’s UM program.

What is the last date for applying to the job?

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