Full-Time Sr Medical Director – Utilization Management (Remote)

• 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.

1. Demonstrate ownership of overall effectiveness and efficiency of UM process and outcomes in close partnership with Director, UM in Health Services.
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, primarily focusing on employee and leader coaching, development, performance improvement, coordination and budgeting for multiple staff, and department specific functions/services.
4. Responsible to perform oversight of independent review organization appeals and ensure effectiveness of end-to-end process for medical appeals in close partnership with nursing leader of appeals process.
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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