Optum
Join us at Optum Home & Community Care, part of the UnitedHealth Group, where we are reinventing health care to offer a truly integrated care model. We focus on addressing the holistic needs of individuals, including physical, mental, and social aspects, helping patients access and navigate care anytime and anywhere.
As a member of the naviHealth product team, you will play a vital role in changing health care delivery from hospital to home, ensuring that older adults enjoy more days in the comfort of their own homes.
We aim to create seamless health journeys for patients across various care settings. Be part of our mission to
Caring. Connecting. Growing together. Why choose naviHealth? At naviHealth, we collaborate with exceptionally talented individuals who strive to make a significant positive impact on society through health care transformation. With nearly two decades of visionary leadership and innovation driving our care transition solutions, we operate differently in the health care industry, focusing on personalized, patient-centered approaches. You will enjoy the flexibility of working remotely while tackling challenging issues. We are currently seeking Medical Directors available during daytime hours across U.S. continental time zones. Your primary responsibilities will include: Overseeing daily utilization and external communication with network physicians and hospitals. Conducting daily utilization management reviews, including authorizations and denial assessments. Engaging in peer-to-peer conversations for clinical case reviews when necessary. Providing telephonic assessments with providers, sharing tools and guidelines related to cost-effective healthcare delivery and quality of care. Effectively communicating with network and non-network providers to facilitate the successful administration of Care Transitions services. Responding to clinical inquiries and serving as a non-promotional medical contact for healthcare providers. Representing Care Transitions at appropriate external forums, engaging with other thought leaders. Collaborating with the Client Services Team to ensure a unified approach in working with delivery system providers. Contributing to strategic action plans and programs that address concerns and monitor progress toward goals. Interacting and collaborating with network and community physicians, hospital leaders, and vendors regarding care and services for enrollees. Providing leadership to maximize cost management through close cooperation with network and vendor contracting. Meeting regularly with Care Transitions leadership to discuss care coordination, develop collaborative intervention plans, and share insights on network management. Providing feedback to the Analytics Team and Client Services Team to enhance Care Transitions' products and services. Managing local queries regarding patient case management, either by addressing them directly or directing them to the appropriate subject matter expert. Participating in the Medical Advisory Board. Providing intermittent, scheduled weekend and evening coverage. Performing other duties and responsibilities as needed. You will be recognized for your performance in a challenging but rewarding environment that sets clear expectations for success while offering career development opportunities. Required qualifications: Board certification as an MD, DO, or MBBS with a current unrestricted license. Ability to obtain and maintain licensure in multiple states. A minimum of 3 years of post-residency patient care experience, preferably in inpatient or post-acute settings. Preferred qualifications: Licensure in multiple states. Willingness to obtain additional state licenses with support from Optum. Understanding of population-based medicine, especially knowledge of CMS criteria for post-acute care. Ability to work effectively in a team environment while managing multiple tasks simultaneously. Capability to complete assignments with minimal oversight. Strong interpersonal skills to foster positive interactions with clinicians, management, and medical professionals. Proficiency in electronic health records and related technologies. Exceptional organizational, analytical, verbal, and written communication skills. High level of ethics and integrity. Strong motivation and adaptability to thrive in a fast-paced, dynamic setting. Employees working remotely must adhere to UnitedHealth Group's Telecommuter Policy. Salary Information:
For California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents: The salary range for this role is $286,104 to $397,743 annually. Actual salaries are based on a variety of factors, including local labor markets, education, work experience, and certifications. UnitedHealth Group is also committed to offering a comprehensive benefits package. Application Deadline:
This posting will be available for a minimum of 2 business days or until we have a sufficient pool of qualified candidates. The posting may close early due to a high volume of applications. At UnitedHealth Group, we strive to improve the health of all individuals and enhance the health system for everyone. We believe in equitable health care access for all, regardless of race, gender, sexuality, age, or income. Our commitment to address health disparities and promote positive health outcomes is a priority reflected in our mission. Diversity creates a healthier workplace: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer, ensuring that all qualified applicants are considered for employment without regard to race, color, religion, sex, age, national origin, disability status, or any other protected characteristic. UnitedHealth Group is a drug-free workplace. Candidates will be required to complete a drug test prior to beginning their employment.
Caring. Connecting. Growing together. Why choose naviHealth? At naviHealth, we collaborate with exceptionally talented individuals who strive to make a significant positive impact on society through health care transformation. With nearly two decades of visionary leadership and innovation driving our care transition solutions, we operate differently in the health care industry, focusing on personalized, patient-centered approaches. You will enjoy the flexibility of working remotely while tackling challenging issues. We are currently seeking Medical Directors available during daytime hours across U.S. continental time zones. Your primary responsibilities will include: Overseeing daily utilization and external communication with network physicians and hospitals. Conducting daily utilization management reviews, including authorizations and denial assessments. Engaging in peer-to-peer conversations for clinical case reviews when necessary. Providing telephonic assessments with providers, sharing tools and guidelines related to cost-effective healthcare delivery and quality of care. Effectively communicating with network and non-network providers to facilitate the successful administration of Care Transitions services. Responding to clinical inquiries and serving as a non-promotional medical contact for healthcare providers. Representing Care Transitions at appropriate external forums, engaging with other thought leaders. Collaborating with the Client Services Team to ensure a unified approach in working with delivery system providers. Contributing to strategic action plans and programs that address concerns and monitor progress toward goals. Interacting and collaborating with network and community physicians, hospital leaders, and vendors regarding care and services for enrollees. Providing leadership to maximize cost management through close cooperation with network and vendor contracting. Meeting regularly with Care Transitions leadership to discuss care coordination, develop collaborative intervention plans, and share insights on network management. Providing feedback to the Analytics Team and Client Services Team to enhance Care Transitions' products and services. Managing local queries regarding patient case management, either by addressing them directly or directing them to the appropriate subject matter expert. Participating in the Medical Advisory Board. Providing intermittent, scheduled weekend and evening coverage. Performing other duties and responsibilities as needed. You will be recognized for your performance in a challenging but rewarding environment that sets clear expectations for success while offering career development opportunities. Required qualifications: Board certification as an MD, DO, or MBBS with a current unrestricted license. Ability to obtain and maintain licensure in multiple states. A minimum of 3 years of post-residency patient care experience, preferably in inpatient or post-acute settings. Preferred qualifications: Licensure in multiple states. Willingness to obtain additional state licenses with support from Optum. Understanding of population-based medicine, especially knowledge of CMS criteria for post-acute care. Ability to work effectively in a team environment while managing multiple tasks simultaneously. Capability to complete assignments with minimal oversight. Strong interpersonal skills to foster positive interactions with clinicians, management, and medical professionals. Proficiency in electronic health records and related technologies. Exceptional organizational, analytical, verbal, and written communication skills. High level of ethics and integrity. Strong motivation and adaptability to thrive in a fast-paced, dynamic setting. Employees working remotely must adhere to UnitedHealth Group's Telecommuter Policy. Salary Information:
For California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents: The salary range for this role is $286,104 to $397,743 annually. Actual salaries are based on a variety of factors, including local labor markets, education, work experience, and certifications. UnitedHealth Group is also committed to offering a comprehensive benefits package. Application Deadline:
This posting will be available for a minimum of 2 business days or until we have a sufficient pool of qualified candidates. The posting may close early due to a high volume of applications. At UnitedHealth Group, we strive to improve the health of all individuals and enhance the health system for everyone. We believe in equitable health care access for all, regardless of race, gender, sexuality, age, or income. Our commitment to address health disparities and promote positive health outcomes is a priority reflected in our mission. Diversity creates a healthier workplace: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer, ensuring that all qualified applicants are considered for employment without regard to race, color, religion, sex, age, national origin, disability status, or any other protected characteristic. UnitedHealth Group is a drug-free workplace. Candidates will be required to complete a drug test prior to beginning their employment.