Optum
Medical Director - Post-Acute Care Management - Care Transitions - Remote
Optum, Austin, Texas, us, 78716
Medical Director - Post-Acute Care Management – Care Transitions (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. Join us to start
Caring. Connecting. Growing together.
Why Care Transitions? At Care Transitions, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. We do health care differently and are changing health care one patient at a time. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. and take on some tough challenges. We are currently looking for Medical Directors that can work daytime in any of the continental time zones in the US.
Primary Responsibilities
Provide daily utilization oversight and external communication with network physicians and hospitals.
Daily UM reviews – authorizations and denial reviews.
Conduct peer‑to‑peer conversations for the clinical case reviews, as needed.
Conduct provider telephonic review and discussion and share tools, information, and guidelines related to cost‑effective health‑care delivery and quality of care.
Communicate effectively with network and non‑network providers to ensure the successful administering of Care Transitions’ services.
Respond to clinical inquiries and serve as a non‑promotional medical contact point for various healthcare providers.
Represent Care Transitions on appropriate external levels, identifying, engaging, and establishing/maintaining relationships with other thought leaders.
Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers.
Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals.
Interact, communicate, and collaborate with network and community physicians, hospital leaders, and other vendors regarding care and services for enrollees.
Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting.
Regularly meet with Care Transitions’ leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues.
Provide input on local needs for Analytics Team and Client Services Team to better enhance Care Transitions’ products and services.
Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME.
Participate on the Medical Advisory Board.
Provide intermittent, scheduled weekend and evening coverage.
Perform other duties and responsibilities as required, assigned, or requested.
Required Qualifications
Current, unrestricted medical license and ability to obtain licensure in multiple states.
Board certification as an MD, DO, MBBS with a current unrestricted license to practice and willingness to maintain necessary credentials to retain the position.
3+ years of post‑residency patient care, preferably in inpatient or post‑acute setting.
Preferred Qualifications
Licensure in multiple states and willingness to obtain additional state licenses, with Optum’s support.
Understanding of population‑based medicine, preferably with knowledge of CMS criteria for post‑acute care.
Demonstrated ability to work within a team environment while completing multiple tasks simultaneously.
Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision.
Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non‑medical professionals.
Demonstrated competence in use of electronic health records as well as associated technology and applications.
Proven excellent organizational, analytical, verbal and written communication skills.
Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues.
Proven highest level of ethics and integrity.
Proven highly motivated, flexible and adaptable to working in a fast‑paced, dynamic environment.
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Compensation Compensation for this specialty generally ranges from $238,000 to $357,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
Equal Employment Opportunity UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
Drug‑Free Workplace Candidates are required to pass a drug test before beginning employment.
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Caring. Connecting. Growing together.
Why Care Transitions? At Care Transitions, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. We do health care differently and are changing health care one patient at a time. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. and take on some tough challenges. We are currently looking for Medical Directors that can work daytime in any of the continental time zones in the US.
Primary Responsibilities
Provide daily utilization oversight and external communication with network physicians and hospitals.
Daily UM reviews – authorizations and denial reviews.
Conduct peer‑to‑peer conversations for the clinical case reviews, as needed.
Conduct provider telephonic review and discussion and share tools, information, and guidelines related to cost‑effective health‑care delivery and quality of care.
Communicate effectively with network and non‑network providers to ensure the successful administering of Care Transitions’ services.
Respond to clinical inquiries and serve as a non‑promotional medical contact point for various healthcare providers.
Represent Care Transitions on appropriate external levels, identifying, engaging, and establishing/maintaining relationships with other thought leaders.
Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers.
Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals.
Interact, communicate, and collaborate with network and community physicians, hospital leaders, and other vendors regarding care and services for enrollees.
Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting.
Regularly meet with Care Transitions’ leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues.
Provide input on local needs for Analytics Team and Client Services Team to better enhance Care Transitions’ products and services.
Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME.
Participate on the Medical Advisory Board.
Provide intermittent, scheduled weekend and evening coverage.
Perform other duties and responsibilities as required, assigned, or requested.
Required Qualifications
Current, unrestricted medical license and ability to obtain licensure in multiple states.
Board certification as an MD, DO, MBBS with a current unrestricted license to practice and willingness to maintain necessary credentials to retain the position.
3+ years of post‑residency patient care, preferably in inpatient or post‑acute setting.
Preferred Qualifications
Licensure in multiple states and willingness to obtain additional state licenses, with Optum’s support.
Understanding of population‑based medicine, preferably with knowledge of CMS criteria for post‑acute care.
Demonstrated ability to work within a team environment while completing multiple tasks simultaneously.
Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision.
Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non‑medical professionals.
Demonstrated competence in use of electronic health records as well as associated technology and applications.
Proven excellent organizational, analytical, verbal and written communication skills.
Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues.
Proven highest level of ethics and integrity.
Proven highly motivated, flexible and adaptable to working in a fast‑paced, dynamic environment.
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Compensation Compensation for this specialty generally ranges from $238,000 to $357,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
Equal Employment Opportunity UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
Drug‑Free Workplace Candidates are required to pass a drug test before beginning employment.
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