UM Medical Director - Family Medicine - Remote

Primary Responsibilities

• Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
• Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements
• Engage with requesting providers as needed in peer-to-peer discussions
• Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
• Participate in daily clinical rounds as requested
• Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
• Communicate and collaborate with other internal partners
• Participate in holiday and call coverage rotation

Required Qualifications

• M.D. or D.O., Board certification in Family Medicine through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
• Active unrestricted medical license and ability to obtain additional state medical licenses as needed
• 5+ years of clinical practice experience after completing residency training
• Proven sound understanding of Evidence Based Medicine (EBM)
• Proven solid PC skills, specifically using MS Word, Outlook, and Excel
• Ability to participate in rotational holiday and call coverage

Preferred Qualifications

• Licensure in TX. IN, KS, NE, AZ, WA, FL or a compact license
• Utilization Management or clinical coverage review experience for an insurance or managed care organization
• Proven excellent oral, written, and interpersonal communication skills, facilitation skills
• Proven innovative problem-solving skills
• Proven presentation skills for both clinical and non-clinical audiences
• Reside in Nebraska or Texas

Pay and Benefits

The salary for this role will range from $248,500 to $373,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.