Market Medical Director, Utilization Management
2 months ago
The Market 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
- Develops strategies for improving all aspects of market performance including RAPS, membership, and medical management
- 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
Customer Service
- Oversees and insures physician compliance with UM plan
- Evaluates performance of physicians in regards to established goals and objectives of the company
- Performs all duties with physicians and medical group staff in a professional and responsible manner
- Responds to physicians in a prompt, pleasant and professional manner
- Respects physician, patient, and organizational confidentiality
- Educates medical groups regarding UM policies, procedures and government-mandated regulations
- 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
- Encourages teamwork and cooperation with medical group staffs in order to prepare for cross training and float positions
- 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
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.) or Doctor of Osteopathy (D.O.) degree
- Board Certified Family Practitioner or Internal Medical Specialist
- Unrestricted licensed in Texas, Florida, Georgia, or New Jersey
- 5+ years of clinical practice experience
- 2+ years of experience in utilization management activities
- Proficiency with Microsoft Office applications
Preferred Qualifications:
- Unrestricted license in New Mexico
- 2+ years of experience with acute admission experience
- 2+ years of experience working in a managed care health plan environment
- Bilingual (English/Spanish) fluency
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $286,104 to $397,743 annually. 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 education, work experience, certifications, etc. 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.
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.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
-
Director of Marketing
2 months ago
San Antonio, United States Pyramid Global Hospitality Full timeOverview La Cantera Resort is in search of a Marketing Director to join our dynamic team! Located northwest of San Antonio in a picturesque setting within Texas Hill Country, La Cantera has established itself as one the state's premier resort destinations. As Director of Marketing, you will play a pivotal role in shaping and executing strategic marketing...
-
Director of Sales and Marketing
1 week ago
San Antonio, United States Penn Foster Inc Full timeSummary: The Director of Sales and Marketing is responsible for the management, coordination, and execution of items related to the entire sales operation of the hotel. This role includes driving the property's group sales, business transient, and catering efforts, managing the Director of Group Sales and Director of Catering Sales, working with the...
-
Director, Marketing
3 weeks ago
San Antonio, Texas, United States teamworkonline Full timePOSITION: Director, Marketing - San Antonio BrahmasReporting to: VP, Business Operations - San Antonio BrahmasLocation: Candidate must live in the San Antonio area. About the UFL The United Football League (UFL) is the premier spring football platform, formed by the merging of the USFL and XFL in 2024. The UFL has eight teams, in Arlington (TX), Birmingham...
-
Director of Marketing
2 days ago
San Antonio, United States Pyramid Global Hospitality Full timeProperty About Us At Pyramid Global Hospitality, people come first. As a company that values its employees, Pyramid Global Hospitality is dedicated to creating a supportive and inclusive work environment that fosters diversity, growth, development, and wellbeing. Our commitment to a People First culture is reflected in our approach to employee development,...
-
Marketing Director
2 months ago
San Antonio, United States Chick-fil-A - Huebner & Babcock Full timeJob DescriptionJob DescriptionAt Chick-fil-A Huebner & Babcock, you will have the opportunity to make a significant positive impact on our Team Members, our guests and our community each day through your passion about the quality of our food, the spirit of our hospitality and the cleanliness of our restaurant. The Role of Marketing Director is to emotionally...
-
Marketing Director
3 months ago
San Antonio, United States Chick-fil-A - Huebner & Babcock Full timeJob DescriptionJob DescriptionAt Chick-fil-A Huebner & Babcock, you will have the opportunity to make a significant positive impact on our Team Members, our guests and our community each day through your passion about the quality of our food, the spirit of our hospitality and the cleanliness of our restaurant. The Role of Marketing Director is to emotionally...
-
Marketing Coordinator
2 months ago
San Antonio, United States Rogers-O'Brien Construction Full timeThe award-winning marketing team at RO has a clear purpose: to inspire growth with creativity and enthusiasm to uniquely impact others as ambassadors of the RO brand. We are creative. We work hard. We are a collaborative team, and we know how to have fun along the way. If you want to push the boundaries and continue to grow your career in construction...
-
Marketing Manager
3 months ago
San Antonio, United States Marriott International Full timeJOB SUMMARY Promotes on-brand messaging to customers through traditional, digital, and social media channels with the goal of driving revenue and supporting total hotel goals. Builds direct marketing plans, targeted campaigns, and activated channels to drive consumer awareness and preference, increasing market share, and building broader portfolio and...
-
San Antonio, United States UnitedHealth Group Full timeDo you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring and join us to start Caring. Connecting. Growing together. The Nurse Case Manager II (NCM) is responsible for patient case management for longitudinal engagement, coordination for...
-
Director of Market Research
4 weeks ago
San Antonio, United States augmentjobs Full timeJob DescriptionJob DescriptionJob Summary: The Director of Market Research will be responsible for overseeing the design, implementation, and analysis of market research initiatives. This role will provide critical insights into market trends, consumer behavior, and competitive landscape to support strategic planning and drive business growth.Key...
-
Director, Marketing
3 weeks ago
San Antonio, United States teamworkonline Full timePOSITION: Director, Marketing - San Antonio BrahmasReporting to: VP, Business Operations - San Antonio BrahmasLocation: Candidate must live in the San Antonio area. About the UFL The United Football League (UFL) is the premier spring football platform, formed by the merging of the USFL and XFL in 2024. The UFL has eight teams, in Arlington (TX), Birmingham...
-
Leasing and Marketing Coordinator
3 days ago
San Antonio, Texas, United States Francis Property Management In Full timePosition Overview:As a Leasing and Marketing Professional, you will have the exciting opportunity to showcase and lease apartment homes while utilizing your marketing skills. Key Responsibilities:We seek a dynamic, self-driven individual with a strong focus on customer service, dedicated to assisting clients in finding their ideal apartment and a wonderful...
-
Utilization Management Nurse
2 weeks ago
San Antonio, United States Gonzaba Medical Group Full timeGeneral Summary: Utilization Management Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be done accurately and in a timely manner. Carries out GMG UM Program activities and UM Operations. Exercise tact and courtesy...
-
Utilization Management Nurse
1 month ago
San Antonio, United States Gonzaba Medical Group Full timeGeneral Summary: Utilization Management Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be done accurately and in a timely manner. Carries out GMG UM Program activities and UM Operations. Exercise tact and courtesy...
-
San Antonio, United States UnitedHealth Group Full timeDo you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring and join us to start Caring. Connecting. Growing together. The Nurse Case Manager II (NCM) is responsible for patient case management for longitudinal engagement, coordination for...
-
San Antonio, United States Optum Full timeDo you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring and join us to start Caring. Connecting. Growing together. The Nurse Case Manager II (NCM) is responsible for patient case management for longitudinal engagement, coordination for...
-
San Antonio, United States Optum Full timeDo you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring and join us to start Caring. Connecting. Growing together. The Nurse Case Manager II (NCM) is responsible for patient case management for longitudinal engagement, coordination for...
-
Director of Marketing
2 months ago
San Jacinto, United States Soboba Casino Full timeJob DescriptionJob DescriptionSummaryThe Director of Marketing, working directly with the Chief Marketing Officer, is responsible for developing and directing all Casino marketing and advertising programs to positively affect Casino patronage and profitability. The Marketing Director also coordinates with the Community Liaison and other Tribal entities to...
-
Director of Marketing
2 days ago
San Jacinto, United States Soboba Casino Full timeSummary The Director of Marketing, working directly with the Chief Marketing Officer, is responsible for developing and directing all Casino marketing and advertising programs to positively affect Casino patronage and profitability. The Marketing Director also coordinates with the Community Liaison and other Tribal entities to ensure all Tribal enterprises...
-
Director of Marketing
1 month ago
San Jacinto, United States Soboba Casino Resort Full timeSummary The Director of Marketing, working directly with the Chief Marketing Officer, is responsible for developing and directing all Casino marketing and advertising programs to positively affect Casino patronage and profitability. The Marketing Director also coordinates with the Community Liaison and other Tribal entities to ensure all Tribal...
