Sr Medical Director – 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. 

Job Description

If not within a commutable distance to a Wellmark office, you will be eligible to work remotely from your home location*, with the expectation of the following travel to the Des Moines, Iowa office:

• First 6 months/Onboarding: Every other week in Des Moines, IA 

• After 6 months: Quarterly in Des Moines, IA

• Additional travel may be required to meet business needs 

*Candidates within driving distance or a direct flight to Des Moines, Iowa are preferred. Central Time Zone preferred.

About the opportunity: 

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.

About you: 

You believe health care can be better and are passionate about finding ways to influence this important work. You are proactive, analytical, innovative, and partner effectively with internal and external stakeholders. You are a skilled communicator and enjoy collaboration with other cross-functional leaders. You are someone who can pivot easily: from performing UM and appeals case reviews, to driving employee engagement and collaboration amongst your team and others, to strategically partnering to develop new total cost of care (TCOC) initiatives. You enjoy variety in your day. You are confident in your decision-making skills and can jump in to assist the team with utilization management while also leading high-level initiatives. You see yourself as a forward-thinking professional and thrive when your work allows you to tap into your creative side to build impactful work from the ground up. 

Qualifications

Preferred Qualifications - Great to have:

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

Required Qualifications - Must have:

• 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 OR an administrative license; must be licensed in the state in which you reside. In the meantime, 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 approved by the American Board of Medical Specialties or American Osteopathic Association.
• 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 determinations.
• In addition, 3+ years of prior experience in a formal or informal administrative leadership role in a healthcare environment such as a managed care orga