Medical Director - Care Transitions Management

Optum is a leading global organization dedicated to improving health outcomes through innovative technology and compassionate care. Join our team to have a direct impact on the lives of millions, helping them connect with the necessary healthcare resources and services they need to thrive. At Optum, you'll experience a culture of inclusion, work alongside talented professionals, and have access to comprehensive benefits and growth opportunities. Together, we can make a significant difference in the communities we serve. Why Care Transitions? Care Transitions is on a mission to revolutionize healthcare by collaborating with passionate individuals who want to create a meaningful impact. With nearly two decades of innovation, we are transforming how care transitions are managed, ensuring patients receive the best possible outcomes. We approach health care differently, focusing on improving one patient at a time in a vibrant and progressive environment. Your role offers flexibility with the opportunity to work remotely from anywhere in the U.S., as long as you are available during daytime hours in your time zone. We are actively seeking Medical Directors to tackle challenging cases and lead care transition initiatives. Key Responsibilities: Oversee daily utilization and maintain external communication with network physicians and hospitals. Conduct daily utilization management (UM) reviews, including authorizations and denials. Engage in clinical case reviews with peer-to-peer discussions as necessary. Provide guidance during provider telephonic reviews, sharing vital tools and information for cost-effective healthcare delivery. Communicate effectively with all healthcare providers to facilitate care transitions. Serve as a medical contact point for various healthcare provider inquiries. Represent Care Transitions in external engagements, establishing relationships with key industry leaders. Collaborate closely with Client Services Team to achieve a unified approach to provider delivery. Drive the development of action plans and programs to implement strategic initiatives and monitor progress. Engage with community physicians, hospital leaders, and vendors regarding patient care services. Provide leadership for cost management in collaboration with network and provider contracting. Work with Care Transitions leadership to discuss care coordination and network management. Contribute valuable insights to the Analytics and Client Services Teams to enhance our offerings. Address patient case management inquiries effectively, directing them to the appropriate experts when needed. Participate actively on the Medical Advisory Board. Provide occasional weekend and evening coverage as required. Perform additional duties and responsibilities as assigned. You will be rewarded for your contributions in an empowering environment, with clear guidance on success, and development opportunities for future roles. Qualifications: Board certification as an MD, DO, or MBBS and current unrestricted medical license. Ability to practice in multiple states, with support for additional state licensure. 3+ years of post-residency patient care experience, ideally in an inpatient or post-acute care setting. Preferred Qualifications: Multi-state medical licensure. Understanding of population-based medicine and CMS criteria for post-acute care. Proven ability to collaborate effectively in a team environment. Strong organizational, analytical, communication, and interpersonal skills. Experience with electronic health records and related technologies. Commitment to ethics and integrity in all professional interactions. Ability to thrive in a fast-paced, dynamic environment. Note: All remote employees must comply with UnitedHealth Group's Telecommuter Policy. The salary for this position ranges from $238,000 to $357,500 annually, reflecting total cash compensation based on various factors, including local labor markets and individual qualifications. Alongside competitive salary, UnitedHealth Group provides a comprehensive benefits package that includes incentive programs, stock purchase options, and retirement contributions. Application Deadline:

Applications will be open for a minimum of 2 business days or until we identify a suitable candidate pool. At UnitedHealth Group, we strive to improve health outcomes for all, advocating for equitable health access regardless of race, gender, or socio-economic background. Join us in our commitment to addressing health disparities and creating a healthier world for everyone. UnitedHealth Group is an Equal Employment Opportunity employer and a drug-free workplace. Candidates are required to undergo a drug test before commencing employment.