Medical Director

Summary

Join Wellmark as a Medical Director for Inpatient Utilization Management! As an experienced M.D. or D.O., you'll perform timely and clinically appropriate inpatient case reviews using evidence-based decision-making. You'll synthesize clinical information to document medical necessity and collaborate with internal teams. This role offers opportunities to recommend process improvements and ensure members receive appropriate care. The position is ideally based in Iowa or South Dakota but remote work is possible. A rotating on-call schedule is required.

Requirements

• Graduate of an accredited medical school; M.D. or D.O. degree is required
• Active and unrestricted license to practice medicine in Iowa or Iowa Administrative Medical License is required within 3 months from date of hire AND must be licensed in the state in which you reside
• Current Board Certification in Emergency Medicine, Family Medicine, or Internal Medicine through the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA)
• 3-5 years of adult inpatient clinical experience in an acute care hospital setting (e.g. inpatient unit or emergency department) sufficient to enable medical judgments regarding appropriateness of inpatient care, medical necessity, and post-acute care
• Ability to participate in rotating on call schedule for weekends and holiday reviews
• Strong analytical and critical thinking skills; makes sound evidence-based decisions
• Demonstrated commitment to service excellence (timeliness, accuracy, quality) and advocacy for member care
• Strong consulting and interpersonal skills. Quickly builds rapport and establishes credibility
• Excellent verbal and written communication skills. Ability to communicate effectively and with clarity with internal and external audiences, and clinical peers, even when conveying difficult decisions and complex information
• Strong change management skills. Creates a clear view of future state and inspires others to advance the vision
• Ability to mentor and guide others and work within the teams. This includes sharing accountability, influencing without direct authority, and effectively listening to others
• Self-starter with strong organization and time management skills. Flexible with changing priorities
• Works well independently and collaborates as a member of a cross-functional team; ability to navigate in a dynamic corporate environment
• Strong technical acumen. Learns new systems and processes quickly (e.g. Microsoft Office, clinical platforms, etc.)

Responsibilities

• Perform timely and clinically appropriate inpatient case reviews using evidence-based decision-making
• Synthesize clinical information to document a clear summary for the basis of medical necessity determinations
• Develop an effective and collaborative relationship with Wellmark’s UM leaders to continually improve the end-to-end UM process by providing ideas and feedback on improvement
• Actively identify opportunities for process improvement or the need for new processes that are observed in the course of day-to-day work. Demonstrates openness to receiving and acting on constructive feedback
• Defend UM decisions internally and externally using evidence-based medicine, sound clinical reasoning, and critical thinking skills
• Actively listen for relevant new information and compelling counterarguments. Revise decision when the fact basis requires it
• Demonstrate sound judgment by seeking consultation from leader on complex UM case reviews
• Effectively engage in peer-to-peer calls. Seek to understand new information that the provider may offer. Effectively and concisely uphold the UM decision or revise the UM decision based on new information when necessary
• Perform overflow Outpatient reviews as needed
• Deep knowledge of, and proficiency in applying, Wellmark’s medical policies, especially for commonly requested outpatient services
• Participate in rotating on call schedule for weekend and holiday reviews
• Other duties as assigned

Preferred Qualifications

Previous administrative medical experience (e.g. clinical coordination, medical consulting, health plan, provider group, hospital group, etc.)

Benefits

Remote Eligible: You will have the flexibility to work where you are most productive. This position is eligible to work fully remote