Medical Director, Utilization Management Physician - Optum - Remote
El Paso, El Paso County, Texas, 79901, USA
Listed on 2026-07-07
-
Doctor/Physician
Medical Doctor, Healthcare Consultant, Internal Medicine Physician, Primary Care Physician
Well Med, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician‑led care organization that is changing the way clinicians work and live.
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 Well Med Medical Management’s utilization management program.
At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career and will empower you to live your best life at work and erience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country.
Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
You’ll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.
- Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values
- Remain current and proficient in CMS criteria hierarchy and organizational determination processes
- Participates in case review and medical necessity determination
- Maintain proficiency in compliance regulations for both CMS and delegated health plans
- Conducts post service reviews issued for medical necessity and benefits determination coding
- Assists in development of medical management, care management, and utilization management protocols
- Performs all other related duties as assigned
- Oversees and ensures physician compliance with UM plan
- Performs all duties in a professional and responsible manner
- Responds to physicians and staff in a prompt, pleasant and professional manner
- Respects physician, patient, and organizational confidentiality
- 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
- 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.), Doctor of Osteopathy (D.O.), or M.B.B.S.
- Board certification in Family Medicine, Internal Medicine, or emergency medicine
- An active, unrestricted medical license (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 (English/Spanish) fluency
* All employees working remotely will be required to adhere to United Health Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience,…
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).