Medical Director – Inpatient Utilization Management

Company Description

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! 

Learn more about our unique benefit offerings here. 

Want to know more? You can learn about life at Wellmark here.

Job Description

About the Opportunity: As an experienced M.D. or D.O. in adult acute care setting(s), you will use evidence-based decision making to perform inpatient case reviews that are timely and clinically appropriate. You will concisely, effectively, and consistently synthesize clinical information to document a clear summary of a medically necessary determination. While case reviews are this role's primary priority and function, you will have the opportunity to make recommendations on efficiencies and innovations to ensure our members are getting appropriate and timely care based on their health plan coverage. You will partner across the organization with other internal teams, such as Business Analytics, Claims, Operations, Actuarial, and BlueCard, to name a few. Join us on this continuous journey as we make health care better for our members! 

About You: You are decisive and have a strong ability to influence internally and externally by appropriately and effectively presenting evidence-based medicine to support a determination. Critical thinking, sound judgment, and decisiveness are key; however, you will be able to draw from your colleagues’ subject matter expertise from various departments, to help make evidence-based prior authorization decisions. You are collaborative by nature and are energized by the opportunity to work in a highly integrated and matrixed culture. Managed care experience in a large commercial organization, such as at another Blue Cross & Blue Shield plan, a plus. 

If this sounds like you, apply to our Medical Director-Inpatient Utilization Management opportunity today! 

Iowa or South Dakota-based candidates preferred but open to remote for the right candidate. 

This full-time position will also work a rotating on-call schedule for weekend and holiday reviews. 

Qualifications

Required Qualifications:

• 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. While obtaining license, the incumbent will participate in training, provide operational guidance and advice, and participate in projects as assigned while licensure is pending approval.
• 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