Medical Director – Utilization Management

This is a fully remote position, open to applicants in Kansas.

📋 Description

• Oversee, provide medical guidance, and support for WellSky’s clinical management solutions and programs in acute, emergency department, and post-acute care settings.

• Offer expertise and leadership in the areas of medical management and care coordination for acute and post-acute care services.

• Drive enhancements of post-acute clinical programs through strategic planning, design, and execution.

• Deliver timely expert medical reviews for acute emergency department and post-acute care services, including skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), long-term acute care hospitals (LTACH), and home health (HH).

• Provide clinical evaluations regarding medical services under review, including post-decision assessments.

• Be accessible for escalations from nursing teams.

• Record clinical review findings, actions, and outcomes in accordance with policy, regulatory, and accreditation standards.

• Offer guidance on clinical operational aspects of emergency department, acute, and post-acute care programs.

• Collaborate with acute emergency department providers to facilitate and/or support care transitions.

• Identify and cultivate innovative opportunities to enhance effectiveness and quality.

• Create educational materials and training while resolving any issues that arise.

• Engage in client Joint Oversight Committees (JOCs) or partner/stakeholder meetings as necessary.

• Perform other assigned responsibilities.

⛳️ Requirements

• Doctoral degree in a pertinent medical field.

• Minimum of 6-8 years of relevant professional experience.

• Active and unrestricted medical license (MD or DO).

• Board certification in a relevant specialty, ideally in Physical Medicine and Rehabilitation, Internal Medicine, Emergency Medicine, or General Surgery.

• Willingness to travel up to 10% as per business requirements.

• Flexibility to work additional or irregular hours as needed.

• Must adhere to applicable security policies and procedures to protect company and client information.

• Ability to sit and view a computer screen for extended periods.

• Applicants for positions based in the U.S. must be legally authorized to work in the United States.

• Verification of employment eligibility is required at the time of hire.

• Certain client-facing roles may necessitate compliance with relevant requirements, such as immunizations and occupational health mandates.

🏝️ Benefits

• Comprehensive medical, including prescription, dental, and vision coverage.

• Mental health support through the Employee Assistance Program (EAP).

• Generous paid time off policy.

• 13 paid holidays throughout the year.

• 100% vested 401(K) retirement plans.

• Educational assistance of up to $2500 per year.