Optum
Join Optum, a globally recognized organization committed to improving health outcomes through innovative technology and care. As a key member of our Clinical Excellence team, you will play a pivotal role in enhancing the care experience for millions by utilizing your expertise in Clinical Documentation Review and DRG coding. We are dedicated to fostering a diverse and inclusive culture, with abundant opportunities for career growth. Make a meaningful impact on the community as we strive for health equity worldwide.
We are seeking an experienced National Medical Director to lead our Value Innovations initiatives. This essential physician will offer guidance on population health and clinical operations, joining a rapidly expanding team focused on value-based programs.
Our mission at Clinical Excellence is to effectively implement, monitor, and execute clinical programs that enhance the patient and provider experience while ensuring superior outcomes at sustainable costs. We support internal physician groups in achieving clinical improvements and capability enhancements.
As a Medical Director, you will independently conduct timely clinical chart reviews and work collaboratively with a diverse team, including other medical directors, nurse coders, and operational staff. You'll drive improvements in existing workflows, provide quality DRG reviews, engage in peer-to-peer conversations, and participate in pilot programs and innovative projects.
Key Responsibilities:
Deliver high-quality DRG-based clinical reviews within our innovative DRG Clinical Review program, while communicating effectively through various channels.
Work closely with medical directors, nurse coders, and operations teams to optimize DRG Clinical Review performance.
Identify opportunities to enhance program success in collaboration with hospital utilization management and claims teams.
Partner with IT to implement AI enhancements in our programs.
Engage in other Value Innovation programs as necessary.
Foster change management initiatives.
Collaborate with regional care delivery organizations in areas of operational excellence.
Build trust-based relationships within teams and with external stakeholders.
Promote teamwork and a culture of continuous improvement.
Demonstrate initiative and a proactive attitude in problem-solving.
In this role, you will be rewarded for your performance in a supportive environment that offers clear pathways for success and opportunities for professional development.
Required Qualifications:
M.D. or D.O. with an active, unrestricted medical license.
Board certified in adult primary care fields (e.g., Internal Medicine, Family Medicine, Hospitalist) or related subspecialties.
A minimum of 3 years of clinical experience post-residency.
Preferred Qualifications:
Experience in DRG clinical documentation and coding collaboration within a hospital or payer setting.
Previous experience with chart reviews (DRG, UM, PA) or as a hospital physician advisor.
UnitedHealth Group is an Equal Employment Opportunity employer. We are committed to creating a diverse workplace and encourage all qualified applicants to apply, regardless of race, national origin, religion, age, gender, sexual orientation, disability, veteran status, or any other characteristic protected by applicable laws.
We operate a drug-free workplace and candidates must pass a drug test prior to employment.