Optum
Optum is a leading global organization committed to enhancing health and wellness through innovative technology and personalized care. Joining our team means directly impacting health outcomes and helping millions lead healthier lives. We foster a culture rooted in inclusion, professionalism, and career growth, making it a great time to start
Caring. Connecting. Growing together. Our Clinical Advocacy & Support team relentlessly focuses on the customer journey, dedicated to exceeding expectations while managing medical claims and delivering clinical coverage. We empower both providers and members with the right tools and information to improve health outcomes, streamline care delivery, and efficiently manage healthcare costs. The Medical Director will play a pivotal role in supporting Enterprise Clinical Services operations, which oversees initial clinical reviews for service requests. Collaborating with leadership and clinical staff, the Medical Director will help establish and optimize clinical processes related to benefit coverage determinations and quality improvement, ensuring our members receive high-quality, cost-effective care. This role emphasizes utilizing clinical expertise in a collaborative environment. The Medical Director will work closely with primary care and specialist physicians to manage medical benefits across various lines of business, ensuring members receive the best possible care. Key Responsibilities: Conduct comprehensive coverage reviews in line with individual member plans and established policies. Document clinical review findings and maintain compliance with all regulatory standards. Engage with requesting providers through peer-to-peer discussions as necessary. Interpret benefit language and apply it during clinical coverage reviews. Participate in daily clinical rounds and collaborate with network and non-network providers. Communicate effectively with internal partners to ensure timely benefit determinations. Participate in call coverage rotation. In this role, you will be recognized for your performance and will benefit from a challenging environment with clear milestones for success and opportunities for professional development. Requirements: M.D. or D.O. Active, unrestricted medical license. Board certification in an ABMS specialty. Minimum of 5 years of clinical practice post-residency. Strong understanding of Evidence-Based Medicine (EBM). Proficient computer skills, particularly in MS Word, Outlook, and Excel. Preferred Qualifications: Board certification in Physical Medicine & Rehabilitation, Internal Medicine, or Family Medicine. Licenses in multiple states. Experience in utilization and clinical coverage reviews. Aptitude for data analysis and interpretation. Strong problem-solving skills. Excellent oral, written, and interpersonal communication capabilities. Strong presentation skills for diverse audiences. Residing in the Pacific Time Zone is preferred. At UnitedHealth Group, we embrace a diverse workforce and strive to create an inclusive environment for all employees. We are committed to equitable care that addresses health disparities and improving health outcomes for everyone. The salary range for this role is between $238,000 and $357,500 annually, depending on various factors such as education, experience, and certifications. We offer a comprehensive benefits package that includes various incentives and retirement plan options. Application Deadline:
This position will remain open for a minimum of 2 business days or until a sufficient candidate pool is met. It may close sooner due to high application volume. UnitedHealth Group is an Equal Employment Opportunity employer. All 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. Our workplace promotes diversity and inclusivity. Candidates may need to pass a drug test before employment.
Caring. Connecting. Growing together. Our Clinical Advocacy & Support team relentlessly focuses on the customer journey, dedicated to exceeding expectations while managing medical claims and delivering clinical coverage. We empower both providers and members with the right tools and information to improve health outcomes, streamline care delivery, and efficiently manage healthcare costs. The Medical Director will play a pivotal role in supporting Enterprise Clinical Services operations, which oversees initial clinical reviews for service requests. Collaborating with leadership and clinical staff, the Medical Director will help establish and optimize clinical processes related to benefit coverage determinations and quality improvement, ensuring our members receive high-quality, cost-effective care. This role emphasizes utilizing clinical expertise in a collaborative environment. The Medical Director will work closely with primary care and specialist physicians to manage medical benefits across various lines of business, ensuring members receive the best possible care. Key Responsibilities: Conduct comprehensive coverage reviews in line with individual member plans and established policies. Document clinical review findings and maintain compliance with all regulatory standards. Engage with requesting providers through peer-to-peer discussions as necessary. Interpret benefit language and apply it during clinical coverage reviews. Participate in daily clinical rounds and collaborate with network and non-network providers. Communicate effectively with internal partners to ensure timely benefit determinations. Participate in call coverage rotation. In this role, you will be recognized for your performance and will benefit from a challenging environment with clear milestones for success and opportunities for professional development. Requirements: M.D. or D.O. Active, unrestricted medical license. Board certification in an ABMS specialty. Minimum of 5 years of clinical practice post-residency. Strong understanding of Evidence-Based Medicine (EBM). Proficient computer skills, particularly in MS Word, Outlook, and Excel. Preferred Qualifications: Board certification in Physical Medicine & Rehabilitation, Internal Medicine, or Family Medicine. Licenses in multiple states. Experience in utilization and clinical coverage reviews. Aptitude for data analysis and interpretation. Strong problem-solving skills. Excellent oral, written, and interpersonal communication capabilities. Strong presentation skills for diverse audiences. Residing in the Pacific Time Zone is preferred. At UnitedHealth Group, we embrace a diverse workforce and strive to create an inclusive environment for all employees. We are committed to equitable care that addresses health disparities and improving health outcomes for everyone. The salary range for this role is between $238,000 and $357,500 annually, depending on various factors such as education, experience, and certifications. We offer a comprehensive benefits package that includes various incentives and retirement plan options. Application Deadline:
This position will remain open for a minimum of 2 business days or until a sufficient candidate pool is met. It may close sooner due to high application volume. UnitedHealth Group is an Equal Employment Opportunity employer. All 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. Our workplace promotes diversity and inclusivity. Candidates may need to pass a drug test before employment.