Medical Director – Inpatient Utilization Management

3 days ago

🗿 South Dakota – Remote

Although this job is listed in South Dakota, this company may be open to hiring remote in other states.

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Wellmark Blue Cross and Blue Shield

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Healthcare Insurance

Wellmark Blue Cross and Blue Shield is a health insurance provider operating primarily in Iowa and South Dakota. The company offers a range of health insurance plans including individual and family plans, Medicare Advantage, Medicare Supplement, and employer group plans. Wellmark emphasizes providing coverage options that meet diverse needs and budgets, and offers resources for managing accounts, payments, and health care access through their online portal, myWellmark. Additionally, Wellmark provides resources for providers, employers, and producers to drive business efficiency and quality in health care services.

1001 - 5000 employees

Founded 1939

⚕️ Healthcare Insurance

📋 Description

• Use evidence-based decision making to perform inpatient case reviews. • Synthesize clinical information to document a clear summary of medically necessary determinations. • Make recommendations on efficiencies and innovations. • Partner across the organization with other internal teams like Business Analytics and Claims. • Participate in rotating on-call schedule for weekend and holiday reviews.

🎯 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. • 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. • Ability to participate in rotating on call schedule for weekends and holiday reviews. • Strong analytical and critical thinking skills. • Demonstrated commitment to service excellence. • Strong consulting and interpersonal skills. • Excellent verbal and written communication skills. • Strong change management skills.

🏖️ Benefits

• Health insurance • Professional development opportunities