Join WellMed, part of the Optum family, as a leader in Utilization Management! We are seeking a dedicated internal medicine or family medicine physician to be part of our transformative Utilization Management team. At Optum, we prioritize clinician-led care to enhance the workforce and clinician experience. Be a part of our mission to improve healthcare outcomes for all. As a Medical Director for Utilization Management, you will play a crucial role in making utilization determinations, identifying trends in care, and proactively suggesting improvements to our program, ensuring we meet the needs of our valued health plan members. You’ll enjoy the flexibility to work remotely from anywhere in the U.S. as you take on exciting challenges. Key Responsibilities: Develop and maintain an efficient utilization management program aligned with company values. Stay proficient in CMS criteria hierarchy and organizational determination processes. Participate in case reviews for medical necessity and coding determinations. Ensure compliance with regulations set by CMS and delegated health plans. Conduct post-service reviews for medical necessity and benefits determinations. Contribute to the development of medical management, care management, and utilization protocols. Perform additional related duties as assigned. Customer Service Excellence: Oversee physician compliance with the UM plan to ensure quality service. Respond courteously and professionally to physicians and staff inquiries. Maintain strict confidentiality for physicians, patients, and organizational data. Provide quality assurance and education on criteria, guidelines, and UM policies. Personal and Professional Growth: Commit to expanding your knowledge within the UM department. Engage actively in physician meetings to share best practices. Help orient new physicians to company policies and resources. Promote the growth of team members through sharing knowledge and supporting continued education. Attend continuing education sessions to remain informed on advancements in medicine. Since our partnership with Optum began in 2011, WellMed has focused on changing the landscape of healthcare for seniors across Texas and Florida. We are dedicated to innovative preventative healthcare for those 65 and older with a network comprising over 22,000 healthcare professionals. Reward and Recognition: In this dynamic environment, you will be recognized for your impact and supported in your career development. Join us to make a significant difference in healthcare while advancing your professional journey! 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 clinical practice experience. Proficient in Microsoft Office applications. Preferred Qualifications: 2+ years of experience in utilization management. 2+ years of experience with acute admissions. 2+ years in a managed care health plan environment. Bilingual (English/Spanish) preferred. All remote employees must adhere to UnitedHealth Group's Telecommuter Policy. The salary for this role ranges from $269,500 to $425,500 annually, based on various factors including experience and market. UnitedHealth Group provides a comprehensive benefits package along with development opportunities for career advancement. Application Deadline: The position will be open for a minimum of 2 business days or until a sufficient applicant pool is established. Early job posting removals may occur due to high application volumes. OptumCare is an Equal Employment Opportunity employer. All qualified applicants will be considered without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, veteran status, or any other characteristic protected by law. OptumCare maintains a drug-free workplace. Candidates are required to pass a drug test before commencing employment.