Medical Director, Utilization Management Physician - Optum - Remote

Well Med, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team.

The Medical Director for Utilization Management will support Well Med Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over- or under‑utilization of services, and proactively suggesting improvements to the utilization management program.

• Assist in development and maintenance of an efficient UM program to meet the needs of health plan members and align with company values
• Remain current and proficient in CMS criteria hierarchy and organizational determination processes
• Participate in case review and medical necessity determination
• Maintain proficiency in compliance regulations for both CMS and delegated health plans
• Conduct post‑service reviews issued for medical necessity and benefits determination coding
• Assist in development of medical management, care management, and utilization management protocols
• Perform all other related duties as assigned

• Oversee and ensure physician compliance with UM plan
• Perform all duties in a professional and responsible manner
• Respond to physicians and staff promptly, pleasantly, and professionally
• Respect physician, patient, and organizational confidentiality
• Provide quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures when criteria are not met
• Engage in personal and physician development
• Strive to expand knowledge of all aspects of the UM department
• Actively participate in physician meetings
• Orient new physicians to company policy and resources available for support
• Assist in growth and development of subordinates by sharing expertise and promoting continued education
• Attend continuing education classes to stay current on medical advancements and innovative practice guidelines

* All employees working remotely will be required to adhere to United Health Group's Telecommuter Policy.

Pay is based on several factors including local labor markets, education, work experience, and certifications. The salary range for this role is $ to $ annually for full‑time employment. Benefits include a comprehensive package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (subject to eligibility). Additional benefits and incentives are available.

• Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S.
• Board certification in Family Medicine, Internal Medicine, or Emergency Medicine
• Active, unrestricted medical license in any state
• 5+ years of post‑residency clinic practice experience
• Proficiency with Microsoft Office applications

• 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 proficiency in English and Spanish

Optum Care 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, protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

Optum Care is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.