No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work. (sm)
The Medical Director will partner with cross-functional teams and senior leaders to ensure that Optum leads the industry in innovative health management strategies and is considered an expert in the field of post-acute care. The role is a physician leader with 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.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Provide daily utilization oversight and external communication with network physicians and hospitals
- Responsible for daily UM reviews - authorizations and denial reviews
- Conduct peer to peer conversations for the clinical case reviews, as needed
- Conduct provider telephonic review and discussion, schedule on-site visits, and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
- Communicate effectively with network and non-network providers to ensure the successful administering of Optum’s services
- Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
- Represent Optum on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders
- Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers
- Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
- Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees
- Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting
- Regularly meet with Optum’s 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 Client Services Team to better enhance Optum’s 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
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.
- Graduate of a recognized medical school and recipient of an M.D. degree
- 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 population
- Strong business acumen, including working knowledge of changing U.S. payer and provider landscape
- Proficiency with MS Office Suite
- Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
- Excellent organizational, verbal and written communication and presentation skills
- Ability to work with others while completing multiple tasks simultaneously and successfully
- Ability to complete assignments with reasonable oversight, direction, and supervision
- Highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment
- Strong interpersonal skills and necessary business acumen to communicate and build positive relationships with management
- Clear, concise and persuasive verbal and written communication
- Must be able to positively interact with other clinicians, senior management, patients and their families, and all levels of medical and non-medical professionals
- Excellent analytic skills
- Highest level of ethics and integrity
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. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance
*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, MD, UM reviews, Medicare, Telecommute