Optum
Join Optum, a global leader in healthcare, where your work will make a significant impact on the health outcomes of millions. We are committed to fostering an inclusive culture, supporting your career development, and providing comprehensive benefits for a fulfilling career. Here, you will be part of a team that is
Caring, Connecting, and Growing together . In the Clinical Advocacy & Support team, we focus relentlessly on enhancing the customer journey in clinical coverage and medical claims review. We empower both providers and members with vital tools and information aiming to improve health outcomes, minimize care variations, and manage healthcare costs effectively. As a Medical Director, you will play a critical role in supporting Enterprise Clinical Services operations. Collaborating with our leadership and staff, you'll help establish and maintain clinical and operational processes related to medical necessity assessments and quality improvement for our members. Your primary focus will be on applying your clinical expertise to utilization management activities, ensuring cost-effective medical care while communicating effectively with various stakeholders. Key Responsibilities: Conduct coverage reviews according to member benefit plans and proprietary policies, delivering accurate coverage determinations. Thoroughly document clinical findings and outcomes in alignment with policies and regulatory standards. Engage in peer-to-peer discussions with requesting providers when necessary. Interpret benefit language and policies skillfully during the clinical review process. Participate in daily clinical rounds as required. Collaborate with network and non-network providers to ensure accurate, timely benefit determinations while educating them on benefit plans and medical policies. Work with internal partners to enhance service delivery. Participate in call coverage rotation. We offer you the flexibility to work remotely, with a preference for candidates residing in the Pacific Time Zone. This role presents challenges that will help you grow professionally while making significant contributions to the healthcare community. Required Qualifications: M.D. or D.O. degree. Active, unrestricted medical license. Board certification in an ABMS specialty. Minimum of 5 years of clinical practice experience following residency. Solid understanding of Evidence-Based Medicine (EBM). Proficient in MS Word, Outlook, and Excel. Preferred Qualifications: Board certification in Physical Medicine & Rehabilitation, Internal Medicine, or Family Medicine. Possession of multiple state licenses. Experience in utilization and clinical coverage review. Strong data analysis and interpretation skills. Proven problem-solving capabilities. Excellent oral, written, and interpersonal communication skills. Strong presentation skills tailored for diverse audiences. Preferred residence in the Pacific Time Zone. Application Deadline:
This role will remain posted for at least two business days or until we gather a sufficient candidate pool. Early closure of posting may occur based on applicant volume. At UnitedHealth Group, our mission is to enhance the health and wellbeing of individuals while striving for a fairer healthcare system. We recognize and address the barriers that affect diverse communities, ensuring everyone has the opportunity for a healthier life. UnitedHealth Group is committed to equal employment opportunities, and we welcome candidates from all backgrounds. We uphold a drug-free workplace; candidates must pass a drug test prior to employment.
Caring, Connecting, and Growing together . In the Clinical Advocacy & Support team, we focus relentlessly on enhancing the customer journey in clinical coverage and medical claims review. We empower both providers and members with vital tools and information aiming to improve health outcomes, minimize care variations, and manage healthcare costs effectively. As a Medical Director, you will play a critical role in supporting Enterprise Clinical Services operations. Collaborating with our leadership and staff, you'll help establish and maintain clinical and operational processes related to medical necessity assessments and quality improvement for our members. Your primary focus will be on applying your clinical expertise to utilization management activities, ensuring cost-effective medical care while communicating effectively with various stakeholders. Key Responsibilities: Conduct coverage reviews according to member benefit plans and proprietary policies, delivering accurate coverage determinations. Thoroughly document clinical findings and outcomes in alignment with policies and regulatory standards. Engage in peer-to-peer discussions with requesting providers when necessary. Interpret benefit language and policies skillfully during the clinical review process. Participate in daily clinical rounds as required. Collaborate with network and non-network providers to ensure accurate, timely benefit determinations while educating them on benefit plans and medical policies. Work with internal partners to enhance service delivery. Participate in call coverage rotation. We offer you the flexibility to work remotely, with a preference for candidates residing in the Pacific Time Zone. This role presents challenges that will help you grow professionally while making significant contributions to the healthcare community. Required Qualifications: M.D. or D.O. degree. Active, unrestricted medical license. Board certification in an ABMS specialty. Minimum of 5 years of clinical practice experience following residency. Solid understanding of Evidence-Based Medicine (EBM). Proficient in MS Word, Outlook, and Excel. Preferred Qualifications: Board certification in Physical Medicine & Rehabilitation, Internal Medicine, or Family Medicine. Possession of multiple state licenses. Experience in utilization and clinical coverage review. Strong data analysis and interpretation skills. Proven problem-solving capabilities. Excellent oral, written, and interpersonal communication skills. Strong presentation skills tailored for diverse audiences. Preferred residence in the Pacific Time Zone. Application Deadline:
This role will remain posted for at least two business days or until we gather a sufficient candidate pool. Early closure of posting may occur based on applicant volume. At UnitedHealth Group, our mission is to enhance the health and wellbeing of individuals while striving for a fairer healthcare system. We recognize and address the barriers that affect diverse communities, ensuring everyone has the opportunity for a healthier life. UnitedHealth Group is committed to equal employment opportunities, and we welcome candidates from all backgrounds. We uphold a drug-free workplace; candidates must pass a drug test prior to employment.