Utilization Management Medical Director - Telecommute

Act as the lead physician reviewer with primary responsibility for UMR and OHUM case reviews averaging 10-20 per day, focused on utilization, case, and disease managementSupport case management team to achieve optimal clinical outcomes for high risk populationsProficient in evidence based clinical guidelines and lead grand round clinical education sessions with nursing teamsPrimary functions include RN case manager support, and consultation about high risk members, and assisting in account management team external presentationsBe involved in telephonic outreach for collaboration with treating providers. This will include discussion of evidence-based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expensesResponsible to collaborate with operational and business partners on clinical and quality initiatives at the site and customer level to address customer expectationsEffectively engage and articulate the Optum and UHC value story to our external constituents such as physicians and our customers. There may also be opportunities to engage medical and specialty societies, hospitals and hospital associations, and state regulatorsDeliver the clinical value proposition focused on quality, affordability and service, in support of the sales and growth activities including conducting Broker / Client presentations and participating in customer consultations By providing 70 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals.At Optum, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imaginedYou'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 with an active, unrestricted medical license in the state of California
• Current Board Certification in an ABMS or AOBMS specialty
• Extensive knowledge/experience of UM processes, systems, and preferably actively performing UM functions
• Excellent written and oral communication skills
• You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this roleEmployees 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 attainedPreferred Qualifications:
  • 5+ years clinical practice experience
  • 2+ years managed care, Quality Management experience and/or administrative leadership experienceCareers 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 for Colorado residents is $254,600 to $295,200 add additional reference for sales and physicians). 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, Board Certified, Clinical Practice, Claims, Utilization Management, Managed Care, Bay Area, CA, California, Telecommute, Remote Keyphrases: health administration jobs, medical director jobs, hospital administration jobs, hospital administrative jobs, healthcare administration jobs, administration jobs, healthcare administrator jobs, medical administration jobs, chief medical officer jobs, medical director position jobs, associate medical director jobs, medical ceo jobs, healthcare ceo jobs, medical administrative jobs, executive director jobs

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