Full-Time Sr Medical Director – Utilization Management

• Managed care experience.
• Board certified in Internal Medicine.
• Experience working in a Hospitalist capacity.
• Involvement in transformational health care initiatives/projects.

• 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.
• 5+ years of adult inpatient clinical experience in an acute care hospital setting.
• 3+ years of prior experience in a formal or informal administrative leadership role in a healthcare environment.
• Proven track record in effective leadership demonstrated by team building, coaching, development, and decision-making skills.
• Masterful at delivering timely UM decisions based on evidence.
• 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.
• Demonstrated sense of ownership, drive and initiative to continuously improve outcomes.
• Track record of teamwork.
• General understanding of medical policy development.
• Demonstrated domain knowledge and ability to be conversant with interpretation and application of data and analysis.
• Possesses superior analytical skills.
• Proficiency with Microsoft Office applications.

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.
5. Responsible for providing exemplary engagement on peer-to-peer calls and escalated UM cases.
6. Responsible for oversight of delegated specialty UM vendor clinical decision-making.
7. Partners with and demonstrate effectiveness with Wellmark’s Business Analytics team to drive each component of product development/new total cost of care (TCOC) initiatives to reduce overuse.
8. Perform other initiatives and projects as required.

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