Optum
Overview
Medical Director DME - Remote at Optum. This role supports Enterprise Clinical Services, providing physician leadership in utilization management, benefit coverage determinations, quality improvement, and cost-effective care for members. Remote work from anywhere in the U.S. (Pacific Time Zone preferred). Primary Responsibilities
Conduct coverage reviews based on individual member plan benefits and applicable coverage review policies; render coverage determinations. Document clinical review findings, actions, and outcomes in accordance with policies and regulatory requirements. Engage with requesting providers in peer-to-peer discussions as needed. Interpret existing benefit language and policies during clinical coverage reviews. Participate in daily clinical rounds as requested. Collaborate with network and non-network providers to achieve accurate and timely benefit determinations; educate providers on benefit plans and medical policy. Collaborate with other internal partners. Call coverage rotation as part of responsibilities. Required Qualifications
M.D. or D.O. Active unrestricted medical license Board certification in Physical Medicine & Rehabilitation, Internal Medicine, or Family Medicine 5+ years of clinical practice after residency Sound understanding of Evidence Based Medicine (EBM) Strong PC skills (MS Word, Outlook, Excel) Preferred Qualifications
Multiple state licenses Experience in utilization and clinical coverage review Data analysis and interpretation aptitude Innovative problem-solving and strong communication/presentation skills Reside in Pacific Time Zone Telecommuter policy adherence for remote employees Compensation and Benefits
Compensation generally ranges from $238,000 – $357,500. Total cash compensation includes base pay and bonus and is based on factors including local labor markets, education, and experience. Benefits include comprehensive packages, incentive programs, equity stock purchase, and 401k contribution. Eligibility requirements apply. UnitedHealth Group is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, or protected veteran status, or any other characteristic protected by law. A drug test may be required.
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Medical Director DME - Remote at Optum. This role supports Enterprise Clinical Services, providing physician leadership in utilization management, benefit coverage determinations, quality improvement, and cost-effective care for members. Remote work from anywhere in the U.S. (Pacific Time Zone preferred). Primary Responsibilities
Conduct coverage reviews based on individual member plan benefits and applicable coverage review policies; render coverage determinations. Document clinical review findings, actions, and outcomes in accordance with policies and regulatory requirements. Engage with requesting providers in peer-to-peer discussions as needed. Interpret existing benefit language and policies during clinical coverage reviews. Participate in daily clinical rounds as requested. Collaborate with network and non-network providers to achieve accurate and timely benefit determinations; educate providers on benefit plans and medical policy. Collaborate with other internal partners. Call coverage rotation as part of responsibilities. Required Qualifications
M.D. or D.O. Active unrestricted medical license Board certification in Physical Medicine & Rehabilitation, Internal Medicine, or Family Medicine 5+ years of clinical practice after residency Sound understanding of Evidence Based Medicine (EBM) Strong PC skills (MS Word, Outlook, Excel) Preferred Qualifications
Multiple state licenses Experience in utilization and clinical coverage review Data analysis and interpretation aptitude Innovative problem-solving and strong communication/presentation skills Reside in Pacific Time Zone Telecommuter policy adherence for remote employees Compensation and Benefits
Compensation generally ranges from $238,000 – $357,500. Total cash compensation includes base pay and bonus and is based on factors including local labor markets, education, and experience. Benefits include comprehensive packages, incentive programs, equity stock purchase, and 401k contribution. Eligibility requirements apply. UnitedHealth Group is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, or protected veteran status, or any other characteristic protected by law. A drug test may be required.
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