Family Practice Full-Time position in San Antonio, Texas
2 months ago
With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind
Caring.
A partner of the OptumCare network, WellMed Medical Group (WMG) is seeking a Utilization Management Medical Director to join our WellMed medical team in the San Antonio office.
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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.
The position will also provide appropriate mentoring and leadership to physicians in the market as well as develop relationships to support growth and fiscal responsibility.
You'll enjoy the flexibility to work remotely \* from anywhere within the U.S. as you take on some tough challenges.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
- Educates primary care physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance related to market activities
- Participates in case review and medical necessity determination
- Conducts post service reviews issued for medical necessity and benefits determination coding
- Analyzes aggregate data and reports to primary care physician
- Serves as the liaison between physicians and health plan Medical Directors
- Supervises the functions of Care Coordination
- Assesses the effectiveness of the specialty network to ensure members have access to multi-specialties within their demographic area
- Represents the providers as an influence to the credentialing committee
- Reviews policies and procedures of credentialing department and offers guidance for revision and implementation of process
- Educates primary care network and assists in problem resolution
- Assists in development of medical management protocols
- Performs analysis of utilization data and suggests/implements corrective action plans with network physicians
- Performs all other related duties as assigned
Required Qualifications:
- Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S
- Active, unrestricted medical license in Texas or the ability to obtain one rapidly
- 5+ years of clinical practice experience
- Proficiency with Microsoft Office applications
Preferred Qualifications:
- Board certification in Family or Internal Medicine
- 2+ years of experience in utilization management activities
- 2+ years of experience working in a managed care health plan environment
- Bilingual (English/Spanish) fluency
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