Medical Director Optum Clinical Services - WY - Telecommute

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's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Optum Clinical Services is focused on driving measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability. In serving our Medicare, Medicaid, and commercial members & plan sponsors, our Optum Clinical Services teams partner with our network of physicians, hospitals and other health care professionals to achieve these goals. We are committed to our mission of helping people live healthier lives.

Primary Responsibilities:

• Working to improve quality and promote evidence-based medicine
• Using data and our ability to engage to help people improve their health and stay healthy
• Providing state-of the-art information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement
• Supporting initiatives that drive better cost and quality through our national network
• Continuing to lead and innovate within the health insurance industry
• Embodying in our words and actions the United Healthcare culture built on the pillars of relationships, compassion, integrity, performance, and innovation
• Ensuring the right service at the right time at the right level of care for each particular member is rendered.

In pursuit of the ongoing achievement of these goals, Optum Clinical Services has Medical Director Teams in place focusing on:

• Inpatient Care Management (ICM), performing concurrent review of facility-based member stays
• Clinical Coverage Review (CCR), performing designated pre-service reviews for our members
• Member Appeals Clinical Review (CR), performing pre- and post-service appeal reviews requested by or on behalf of our members Medical Claim Review (MCR), performing pre-payment and reconsideration clinical claim reimbursement reviews for our providers and facilities
• Provider Appeals Clinical Review (CR), performing post-service clinical claim-related appeals reviews for our providers and facilities.
• Support case and disease management teams to achieve optimal clinical outcomes for high risk populations
• Proficient in evidence based clinical guidelines and lead clinical discussions with nursing teams
• Serve to develop, improve, and evaluate the critical thinking skills of the nurses, to achieve the highest quality and efficiency outcomes.
• Effectively engage and articulate the Optum and UHC value story to our external constituents such as physicians and our customers
  
  

At Optum, you will perform within an innovative culture that focuseds on transformational change in the healthcare system. You will leverage your skills across a diverse and multifaceted business. And you will make contributions that will have an impact that’s greater than you ever imagined.

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.

Required Qualifications:

• MD or DO degree
• Active unrestricted physician state license
• Current board certification in ABMS or AOA specialty
• 5+ years of clinical practice experience post residency
• Strong understanding of and concurrence with evidence-based medicine (EBM) and managed care principles, as well as familiarity with current medical issues and practices
• Proficiency with Microsoft Office applications
• Excellent written and oral communication skills
• Professionally-appropriate written vocabulary and grammar skills, including the ability to modify for different audiences
• Current license in Massachusetts or Wyoming
• Board Certification in Family Medicine or Internal Medicine
• If you need to enter a work site for any reason, you will be 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. 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

Preferred Qualifications:

• Hands-on utilization &/or quality management experience
• Mentoring and coaching experience
• Project management or active project participation experience
• Excellent presentation skills for both clinical and non-clinical audiences
• Substantial experience in using electronic clinical systems

Careers with Optum . Here's the idea. We built an entire organization around one giant objective; make the health system 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. 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, DO, AMBS, AOA, Family Medicine, Internal Medicine, Telecommute, Telcommuter, Telecommuting, Remote