Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs.
The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in inpatient case reviews for the UnitedHealthcare 30-Day Readmission Review program. This post-service review program involves complex case review of readmissions for quality of care and proper billing, in relation to federal, state and health plan guidance.
The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. It is the primary responsibility of the medical director to ensure that the appropriate and most cost effective quality medical care is provided to members.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. TX or TN license would be ideal but not necessary.
- Conduct 30-day readmission quality of care and billing initial determinations
- Perform reconsideration reviews of readmission quality of care and billing initial adverse 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 federal statutes/guidelines and health plan policies in the process of 30-day readmission reviews
- Participate in nursing clinical rounds as requested
- Communicate and collaborate with other internal partners
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- M.D or D.O.
- Board certification approved by the American Board of Medical Specialties (ABMS)
- Active unrestricted license to practice medicine
- 5+ years of clinical practice experience after completing residency training
- Sound understanding of Evidence Based Medicine (EBM)
- Solid PC skills, specifically using MS Word, Outlook, and Excel
- Experience managing Medicare Advantage membership
- Experience with performing quality of care reviews, such as readmission review
- History of providing inpatient Medicine and/or Hospitalist care
- Excellent oral, written, and interpersonal communication skills, facilitation skills
- Data analysis and interpretation aptitude
- Innovative problem solving skills
- Excellent presentation skills for both clinical and non-clinical audiences
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Colorado Residents Only: The salary range for Colorado residents is $254,600 to $295,200. The range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Medical Director, Clinical Advocacy Support, MD, Medical Doctor, Physician, Medicine, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote