Medical Director (Utilization Management)

About the role

The Medical Director is responsible for providing oversight, medical guidance and support to the full spectrum of WellSky's clinical management acute, emergency department, and post-acute care solutions and programs. The scope of this job includes providing expertise and leadership in medical management, as well as care coordination activities for acute and post-acute care services.

Location: This is a remote position. Candidates located within 50 miles of WellSky's headquarters in Overland Park, KS will join our WHQ community and participate in our in-office collaboration experience.

Key Responsibilities

• Lead improvements of post-acute clinical programs by driving strategy, design, and implementation.
• Provide timely expert medical review for acute (ED) and post-acute care services (SNF, IRF, LTACH, HH), provide a clinical opinion about the medical service under review (including post-decision reviews), and be available for escalations from the nurse teams.
• Document clinical review findings, actions, and outcomes per policy and in accordance with regulatory and accreditation requirements.
• Provide guidance for clinical operational aspects of the ED, acute, and post-acute care programs.
• Collaborate with acute ED providers to coordinate and/or support care transitions.
• Identify and develop opportunities for innovation to increase effectiveness and quality, including education development, training, and issue resolution.
• Participate in client JOCs or partner/stakeholder meetings as needed.
• Perform other job duties as assigned.

Required Qualifications

• Doctoral degree in a relevant medical field
• At least 6-8 years of relevant work experience
• Active, unrestricted medical license (MD or DO)
• Board certification in a relevant specialty (preferably in Physical Medicine and Rehabilitation, Internal Medicine, Emergency Medicine, or General Surgery)

Job Expectations

• Willing to travel up to 10% based on business needs
• Willing to work additional or irregular hours as needed
• Must work in accordance with applicable security policies and procedures to safeguard company and client information
• Must be able to sit and view a computer screen for extended periods of time

• #LI-OF1
• #LI-Remote

• WellSky is where independent thinking and collaboration come together to create an authentic culture.
• We thrive on innovation, inclusiveness, and cohesive perspectives.
• At WellSky you can make a difference.

Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky:

• Excellent medical with Rx, dental, and vision benefits
• Mental Health support through EAP
• Generous paid time off, plus 13 paid holidays
• 100% vested 401(K) retirement plans
• Educational assistance up to $2500 per year

Additional information

Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates.

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