Optum
Medical Director - Clinical Review / DRG - Remote
Optum, Minneapolis, Minnesota, United States, 55400
Overview
Medical Director - Clinical Review / DRG - Remote. Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Summary Clinical Excellence, a national OptumCare team, is seeking an experienced National Medical Director to join our Value Innovations efforts. This physician will provide expertise and leadership on population health, specifically Clinical Documentation Review with expertise in DRG coding and clinical operations. The position supports rapid expansion of value-based initiatives and programs.
Responsibilities
Provide consistent high-quality DRG-based clinical reviews within the Optum Enterprise Innovative DRG Clinical Review program and communicate effectively in writing and speech (e.g., letters, peer-to-peer discussions).
Collaborate with a team of medical directors, nurse coders, and operations staff to deliver DRG Clinical Review performance.
Identify opportunities to expand and optimize program success in collaboration with hospital utilization management and claims adjudication teams.
Collaborate with IT partners to implement AI enhancements within programs.
Participate in other Value Innovation programs as assigned.
Engage in change management and cross-collaboration with regional care delivery organizations through OH and Payment Integrity.
Partner with IT on development and implementation of program delivery.
Establish strong, trust-based relationships within the team and with external partners; demonstrate emotional maturity and EQ.
Foster teamwork and a culture of continuous improvement and accountability.
Take initiative and approach problems with energy and passion; work well in a tight-knit, diverse team.
Qualifications
MD or DO with an active, unrestricted medical license.
Board certified in adult primary care fields (e.g., Internal Medicine, Family Medicine, Hospitalist) or related subspecialties.
3+ years of clinical experience post-residency.
Preferred Qualifications
Experience with DRG clinical documentation and/or coding team collaboration within a hospital system or payer.
Experience in chart review (DRG, UM, PA) or prior role as hospital physician advisor.
Remote work: adherence to UnitedHealthcare Group’s Telecommuter Policy.
Compensation and Benefits Pay is based on factors including local labor markets, education, work experience, and certifications. In addition to salary, benefits include a comprehensive package, incentive and recognition programs, equity stock purchase and 401k contribution (subject to eligibility). Salary range for this role is $269,500 to $425,500 annually for full-time employment. We comply with all applicable minimum wage laws.
Application and Policies Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool is collected. The posting may close early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We are committed to equitable care and to mitigating our impact on the environment. UnitedHealth Group is an Equal Employment Opportunity employer; qualified applicants will receive consideration without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status. UnitedHealth Group is a drug-free workplace; candidates are required to pass a drug test before beginning employment.
Seniority level Director
Employment type Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
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Summary Clinical Excellence, a national OptumCare team, is seeking an experienced National Medical Director to join our Value Innovations efforts. This physician will provide expertise and leadership on population health, specifically Clinical Documentation Review with expertise in DRG coding and clinical operations. The position supports rapid expansion of value-based initiatives and programs.
Responsibilities
Provide consistent high-quality DRG-based clinical reviews within the Optum Enterprise Innovative DRG Clinical Review program and communicate effectively in writing and speech (e.g., letters, peer-to-peer discussions).
Collaborate with a team of medical directors, nurse coders, and operations staff to deliver DRG Clinical Review performance.
Identify opportunities to expand and optimize program success in collaboration with hospital utilization management and claims adjudication teams.
Collaborate with IT partners to implement AI enhancements within programs.
Participate in other Value Innovation programs as assigned.
Engage in change management and cross-collaboration with regional care delivery organizations through OH and Payment Integrity.
Partner with IT on development and implementation of program delivery.
Establish strong, trust-based relationships within the team and with external partners; demonstrate emotional maturity and EQ.
Foster teamwork and a culture of continuous improvement and accountability.
Take initiative and approach problems with energy and passion; work well in a tight-knit, diverse team.
Qualifications
MD or DO with an active, unrestricted medical license.
Board certified in adult primary care fields (e.g., Internal Medicine, Family Medicine, Hospitalist) or related subspecialties.
3+ years of clinical experience post-residency.
Preferred Qualifications
Experience with DRG clinical documentation and/or coding team collaboration within a hospital system or payer.
Experience in chart review (DRG, UM, PA) or prior role as hospital physician advisor.
Remote work: adherence to UnitedHealthcare Group’s Telecommuter Policy.
Compensation and Benefits Pay is based on factors including local labor markets, education, work experience, and certifications. In addition to salary, benefits include a comprehensive package, incentive and recognition programs, equity stock purchase and 401k contribution (subject to eligibility). Salary range for this role is $269,500 to $425,500 annually for full-time employment. We comply with all applicable minimum wage laws.
Application and Policies Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool is collected. The posting may close early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We are committed to equitable care and to mitigating our impact on the environment. UnitedHealth Group is an Equal Employment Opportunity employer; qualified applicants will receive consideration without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status. UnitedHealth Group is a drug-free workplace; candidates are required to pass a drug test before beginning employment.
Seniority level Director
Employment type Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
#J-18808-Ljbffr