Medical Director, Utilization Management Physician - WellMed - Remote
Company: Optum
Location: Miami
Posted on: May 12, 2025
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Job Description:
WellMed, part of the Optum family of businesses, is seeking an
internal medicine or family medicine physician to join our
Utilization Management team. Optum is a clinician-led care
organization that is changing the way clinicians work and live.
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As a member of the Optum Care Delivery team, you'll be an integral
part of our vision to make healthcare better for everyone.
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At Optum, you'll have the clinical resources, data and support of a
global organization behind you so you can help your patients live
healthier lives. Here, you'll work alongside talented peers in a
collaborative environment that is guided by diversity and inclusion
while driving towards the Quadruple Aim. We believe you deserve an
exceptional career, and will empower you to live your best life at
work and at home. Experience the fulfillment of advancing the
health of your community with the excitement of contributing new
practice ideas and initiatives that could help improve care for
millions of patients across the country. Because together, we have
the power to make health care better for everyone. Join us and
discover how rewarding medicine can be while Caring. Connecting.
Growing together.
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The Medical Director for Utilization Management will support
WellMed Medical Management, Inc. by making utilization management
determinations, identifying utilization trends suggesting possible
over or under utilization of services and proactively suggesting
improvements to WellMed Medical Management's utilization management
program.
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You'll enjoy the flexibility to work remotely * from anywhere
within the U.S. as you take on some tough challenges.
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Position Highlights & Primary Responsibilities:
Assists in development and maintaining an efficient UM program to
meet the needs of the health plan members and commensurate with
company values
Remain current and proficient in CMS criteria hierarchy and
organizational determination processes
Participates in case review and medical necessity determination
Maintain proficiency in compliance regulations for both CMS and
delegated health plans
Conducts post service reviews issued for medical necessity and
benefits determination coding
Assists in development of medical management, care management, and
utilization management protocols
Performs all other related duties as assigned.
Customer Service
Oversees and ensures physician compliance with UM plan
Performs all duties in a professional and responsible manner
Responds to physicians and staff in a prompt, pleasant and
professional manner
Respects physician, patient, and organizational confidentiality
Provides quality assurance and education of current medical
technologies, review criteria, accepted practice of medicine
guidelines, and UM policies and procedures with counsel when
criterion are not met
Personal and Physician Development
Strives to personally expand working knowledge of all aspects of
the UM department
An active participant in physician meetings
Orients new physicians to ensure understanding of company policy
and resources available for physician support
Assists in the growth and development of subordinates by sharing
special knowledge with others and promotes continued education
classes
Attends continuing education classes to keep abreast of medical
advancements and innovative practice guidelines
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In 2011, WellMed partnered with Optum to provide care to patients
across Texas and Florida. WellMed is a network of doctors,
specialists and other medical professionals that specialize in
providing care for more than 1 million older adults with over
16,000 doctors' offices. At WellMed our focus is simple. We're
innovators in preventative health care, striving to change the face
of health care for seniors. WellMed has more than 22,000+ primary
care physicians, hospitalists, specialists, and advanced practice
clinicians who excel in caring for 900,000+ older adults. Together,
we're making health care work better for everyone.
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You'll be rewarded and recognized for your performance in an
environment that will challenge you and give you clear direction on
what it takes to succeed in your role as well as provide
development for other roles you may be interested in.Required
Qualifications:
Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or
M.B.B.S.
Board certification in Family Medicine or Internal Medicine
An active, unrestricted medical license (any state)
5+ years of post-residency clinic practice experience
Proficiency with Microsoft Office applications
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Preferred Qualifications:
2+ years of experience in utilization management activities
2+ years of experience with acute admissions
2+ years of experience working in a managed care health plan
environment
Bilingual (English/Spanish) fluency
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The salary range for this role is $ $238,000 to $ $357,500 per
year. Salary Range is defined as total cash compensation at target.
The actual range and pay mix of base and bonus is variable based
upon experience and metric achievement. Pay is based on several
factors including but not limited to local labor markets,
education, work experience, certifications, etc. UnitedHealth Group
complies with all minimum wage laws as applicable. In addition to
your salary, UnitedHealth Group offers benefits such as, a
comprehensive benefits package, incentive and recognition programs,
equity stock purchase and 401k contribution (all benefits are
subject to eligibility requirements). No matter where or when you
begin a career with UnitedHealth Group, you'll find a far-reaching
choice of benefits and incentives.
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Application Deadline: This will be posted for a minimum of 2
business days or until a sufficient candidate pool has been
collected. Job posting may come down early due to volume of
applicants.
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*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy
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OptumCare is an Equal Employment Opportunity employer under
applicable law and qualified applicants will receive consideration
for employment without regard to race, national origin, religion,
age, color, sex, sexual orientation, gender identity, disability,
or protected veteran status, or any other characteristic protected
by local, state, or federal laws, rules, or regulations.
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OptumCare is a drug-free workplace. Candidates are required to pass
a drug test before beginning employment.
Keywords: Optum, Miami , Medical Director, Utilization Management Physician - WellMed - Remote, Executive , Miami, Florida
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