Sr Medical Director – Utilization Management

Wellmark, Inc. • Des Moines, IA

180d

About The Position

As Senior Medical Director for Utilization Management (UM), you will be an effective change leader and help develop and guide the strategic direction for Utilization Management initiatives at Wellmark. As a leader of others, you will directly impact the success, growth, and development of team members by setting clear expectations, coaching to each team member’s strengths, and fostering a team-centric work environment. Being a role model in behaviors that demonstrate Wellmark’s Leader Success Expectations and inclusion are essential. A top candidate will be a self-directed and results-oriented physician who leads by example to serve as Wellmark's subject matter expert on effective and efficient processes to reduce overuse and improve quality for our members. You will strategically collaborate with the Health Services team and across the organization to develop and maintain accountability for initiatives to reduce overuse with results that are validated by Wellmark’s analytical team and are grounded in evidence-based care. Internal + external relationship and trust building is essential for success.

Requirements

• 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.
• 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.
• Strong interpersonal skills including clear and concise written and verbal communication.
• Proven ability to set clear goals/expectations and motivate teams to achieve success.
• Demonstrated sense of ownership, drive and initiative to continuously improve outcomes.
• General understanding of medical policy development.
• Demonstrated domain knowledge and ability to be conversant with interpretation and application of data and analysis.
• Proficiency with Microsoft Office applications.

Nice To Haves

• Board certified in Internal Medicine.
• Experience working in a Hospitalist capacity.
• Involvement in transformational health care initiatives/projects.

Responsibilities

• Demonstrate ownership of overall effectiveness and efficiency of UM process and outcomes in close partnership with Director, UM in Health Services.
• Demonstrate deep expertise in delivering UM inpatient and outpatient decisions, especially on complex cases.
• Provide leadership and day-to-day management of financial and human resources, focusing on employee and leader coaching, development, performance improvement, coordination and budgeting for multiple staff.
• Responsible to perform oversight of independent review organization appeals and ensure effectiveness of end-to-end process for medical appeals.
• Responsible for providing exemplary engagement on peer-to-peer calls and escalated UM cases.
• Responsible for oversight of delegated specialty UM vendor clinical decision-making.
• Partner with Wellmark’s Business Analytics team to drive each component of product development/new total cost of care (TCOC) initiatives to reduce overuse.
• Perform other initiatives and projects as required.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees