Job description

This is a temp-to-perm position.

The Medical Director will partner with cross-functional teams and senior leaders to ensure that leading in the industry in innovative health management strategies and is considered an expert in the field of post-acute care. The role as a physician leader, has a proven track record of innovation, achievement of measurable goals, and exceptional clinical competencies. They take a proactive approach to the marketplace and are responsible for continuously reshaping Optum’s corporate wide strategies.

JOB DUTIES:

• Provide daily utilization oversight and external communication with network physicians and hospitals
• Responsible for daily UM reviews - authorization and denial reviews
• Conduct peer to peer conversations for clinical case reviews; as needed
• Conduct provider telephonic review and discussion, share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
• Communicate effectively with providers to ensure the successful administering of services
• Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
• Collaborate with Team to ensure a coordinated approach toward our member’s health care
• the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
• Provide leadership and guidance to maximize cost management through close coordination with network and provider contracting
• Regularly meet with leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues
• Provide input on local needs for Analytics Team and Care Management Team to better enhance products and services
• Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME
• Perform other duties and responsibilities as required, assigned, or requested

Required Qualifications:

• Graduate of a recognized accredited medical school
• Board certified in a recognized ABMS specialty
• Must possess at least a current, unrestricted medical license and the ability to obtain licensure in multiple states
• At least 3 years of experience practicing in an acute inpatient environment, where dealing with managed care organizations made up at least half of inpatient practice
• Understanding of population-based medicine with preference given to significant experience with the Medicare, Medicaid, and Commercial populations
• Strong business acumen, including working knowledge of changing U.S. payer and provider landscape
• Able to quickly adapt to change and drive innovation within team and market
• Must possess a high level of organizational skills, self- motivation, and ability to manage time independently.
• Ability to work across functions and businesses to achieve business goals.
• Ability to develop and maintain positive customer and provider relationships.
• Proficient computer skills
• Required to have a dedicated work area established that is separated from other living areas and provides privacy
• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection

#INDMLK

Job Type: Full-time

Pay: $120.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

License/Certification:

• board certification in a recognized ABMS specialty (Required)

Work Location: Remote

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