Optum
Medical Director, Utilization Management Physician - WellMed - Remote
Optum, New York, New York, United States
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Medical Director, Utilization Management Physician - WellMed - Remote
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Optum WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, youll be an integral part of our vision to make healthcare better for everyone. At Optum, youll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, youll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over or under utilization of services and proactively suggesting improvements to WellMed Medical Managements utilization management program. Youll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Position Highlights & Primary Responsibilities Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values Remain current and proficient in CMS criteria hierarchy and organizational determination processes Participates in case review and medical necessity determination Maintain proficiency in compliance regulations for CMS and delegated health plans Conducts post service reviews issued for medical necessity and benefits determination coding Assists in development of medical management, care management, and utilization management protocols Performs all other related duties as assigned
Customer Service
Oversees and ensures physician compliance with UM plan Performs all duties in a professional and responsible manner Responds to physicians and staff in a prompt, pleasant and professional manner Respects physician, patient, and organizational confidentiality Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met
Personal And Physician Development
Strives to personally expand working knowledge of all aspects of the UM department An active participant in physician meetings Orients new physicians to ensure understanding of company policy and resources available for physician support Assists in the growth and development of subordinates by sharing special knowledge with others and promotes continued education classes Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines
The salary range for this role is $269,500 to $425,500 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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, youll find a far-reaching choice of benefits and incentives. Application Deadline:
This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Seniority level Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
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Medical Director, Utilization Management Physician - WellMed - Remote
role at
Optum WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, youll be an integral part of our vision to make healthcare better for everyone. At Optum, youll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, youll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over or under utilization of services and proactively suggesting improvements to WellMed Medical Managements utilization management program. Youll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Position Highlights & Primary Responsibilities Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values Remain current and proficient in CMS criteria hierarchy and organizational determination processes Participates in case review and medical necessity determination Maintain proficiency in compliance regulations for CMS and delegated health plans Conducts post service reviews issued for medical necessity and benefits determination coding Assists in development of medical management, care management, and utilization management protocols Performs all other related duties as assigned
Customer Service
Oversees and ensures physician compliance with UM plan Performs all duties in a professional and responsible manner Responds to physicians and staff in a prompt, pleasant and professional manner Respects physician, patient, and organizational confidentiality Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met
Personal And Physician Development
Strives to personally expand working knowledge of all aspects of the UM department An active participant in physician meetings Orients new physicians to ensure understanding of company policy and resources available for physician support Assists in the growth and development of subordinates by sharing special knowledge with others and promotes continued education classes Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines
The salary range for this role is $269,500 to $425,500 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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, youll find a far-reaching choice of benefits and incentives. Application Deadline:
This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Seniority level Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
#J-18808-Ljbffr