Medical Director, Utilization Management Physician - WellMed - Remote - UnitedHealth Group : Job Details

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 Customer Service: 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...Medical Director, Physician, Management, Medical, Director, Remote, Healthcare