Medical Director jobs at Concentra - 44 jobs

Physician Center Medical Director
Concentra 4.1
Medical director job at Concentra
Concentra is seeking a Physician to be Center Medical Director for an outpatient location in Columbus, OH (East Side). In this role we are looking for a physician with experience in Family Medicine, Urgent Care, Sports Medicine, Emergency Medicine and/or Occupational Medicine or an interest in making a career move into Occupational Medicine! Recruitment bonus available up to $75,000 for physician who joins Concentra. As a Center Medical Director at Concentra you will be a vital member of our patient care team and play a crucial role in providing exceptional care to our patients. Our mission is to improve the health of America's workforce, one patient at a time. Join us at Concentra and see how your clinical competency and compassion can make a meaningful difference in the lives of the patients you serve. The Center Medical Director ensures consistency of clinical care delivery, clinician onboarding, as well as supporting market clinical and financial strategies and tactics as determined by the director team. Center Medical Directors have responsibilities of onboarding, coaching, and ensuring that standard workflows are performed and clinical delivery is best in class. Center Hours: Monday-Friday 8a-5p (no off hour call responsiblities) Responsibilities * 100% center based providing direct patient care, mentoring, leading by example, and demonstrating clinical excellence and an exceptional patient experience. Assumes role and responsibilities of CMD, whether functioning in the capacity of a CMD at a specific location or in the capacity of the Market Float providing coverage for an open CMD position. * Collaborates under Director of Medical Operations (DMO) direction to identify opportunities to improve clinical quality, workflows, safety, center performance, patient and client experience and satisfaction metrics, or other facets of the practice. * Works with director team (primarily Director of Medical Operations, DMO and Director of Therapy Operations, DTO) to identify clinical improvement opportunities and ensure appropriate support and workflow compliance that foster an environment optimal for patient care. * Mentors and trains future clinical leaders as well as newly hired and tenured clinicians. Fosters an environment of collaboration, professionalism, patient/colleague safety, quality care, continuous improvement and reward and recognition. * Understands center financial drivers and outcomes, along with available tools in order to achieve annual business and strategic plans. Assists CMD's to understand same. * Maintains and leverages relationships with employers, payers, referral sources, networks, and local communities to drive market growth. Responds to requests and issues within 24 hours. * Assists with the planning of clinician meetings, leads, or assists in conducting * Assists DMO and EA in managing staffing in centers and adjustments for unforeseen coverage needs * May be required to observe drug/alcohol testing of patients This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Qualifications * Board Certified in Occupational Medicine, Emergency Medicine, Family Medicine, Internal Medicine, or Physiatry related from ABMS or AOA * Current unrestricted medical license in state of Ohio as required for clinical and/or business duties * Unrestricted DEA registration in Ohio * CMS/Medicare enrollment * Medical degree (MD) or Doctor of Osteopathy (DO) degree from accredited institution * DOT FMCSA certification (current or willing to get during credentialing process) Job-Related Experience * Preferred two years' directly applicable experience including relevant clinical and supervisory experience for clinical scope * Preferred two years' experience in managed care and physician management. * Experience developing and leading medical management and quality improvement programs, preferably in a managed care setting. Job-Related Skills/Competencies * Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility * Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions * Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism * The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies * Agrees, supports, and commits to Concentra's core practice standards and Policies and Procedures * Excellent communication skills including speaking, presentation, listening, telephone, negotiation, business, and medical writing skills necessary to convey information to supervisors, peers, or customers * Demonstrate a high level of skill with interpersonal relationships and communications. * Working knowledge of Human Resource principles and practices of personnel recruitment, selection, coaching and other aspects of performance management Proven ability to effectively supervise other professionals * Skilled in reviewing the clinical work of others according to professional standards and practice guidelines * Ability to supervise, evaluate, coach, and develop staff * Fosters a cooperative and harmonious working climate conducive to maximize employee morale and productivity * Ability to "put patients first" and enjoys treating patients Superior patient/customer service and "bed side manner" skills * Must be a team player in a multidisciplinary environment Demonstrates a value of all contributions to product and outcome * Displays a professional, approachable, and selfless demeanor (no arrogance) at all times both to external and internal clients * Ability to display high degree of inspiration for team members to retain focus of providing highest levels of customer satisfaction * Willingness to learn and continuously improve, to be audited, observed, and reviewed; is positively responsive to feedback Additional Data * Center hours M-F, 8 to 5; so no nights, no weekends, no holidays, and no call * Compensation package: * Competitive base salary with annual merit increase opportunity * Monthly Medical Director Stipend * Monthly RVU Bonus Incentive * Quarterly Quality Care Bonus Incentive * Generous Paid Time Off package for new colleagues include: * 24 days of Paid Time Off (annually, with roll-over) * 5 days of Paid CME Time (annually) * 6 Paid Holidays * Medical Malpractice Coverage * Reimbursement for dues upon approval, for the renewal of applicable licensure, certifications, memberships, etc. * 401(k) with Employer Match * Tuition Reimbursement opportunity * Medical/Vision/Prescription/Dental Plans * Life/Disability Insurance: * Colleague Referral Bonus Program * Opportunity to teach residents and students * Training provided in Occupational Medicine * Supplemental health benefits (accident, critical illness, hospital indemnity insurance) * Pre-tax spending accounts (health care and dependent care FSA) * Concentra accredited CME courses * Leadership development programs * Relocation assistance (when applicable) * Colleague discount program * Unmatched opportunities for advancement locally and nationally This job requires access to confidential and critical information, requiring ongoing discretion and secure information management. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation. Concentra is an equal opportunity employer that prohibits discrimination, and will make decisions regarding employment opportunities, including hiring, promotion and advancement, without regard to the following characteristics: race, color, national origin, religious beliefs, sex (including pregnancy), age, disability, sexual orientation, gender identity, citizenship status, military status, marital status, genetic information, or any other basis protected by federal, state or local fair employment practice laws. #LI-MP1
$165k-242k yearly est. Auto-Apply 60d+ ago

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Physician Center Medical Director
Concentra 4.1
Medical director job at Concentra
Concentra is seeking a Physician to be Center Medical Director for an outpatient location in Columbus, OH (East Side). In this role we are looking for a physician with experience in Family Medicine, Urgent Care, Sports Medicine, Emergency Medicine and/or Occupational Medicine or an interest in making a career move into Occupational Medicine! Recruitment bonus available up to $75,000 for physician who joins Concentra. As a Center Medical Director at Concentra you will be a vital member of our patient care team and play a crucial role in providing exceptional care to our patients. Our mission is to improve the health of America's workforce, one patient at a time. Join us at Concentra and see how your clinical competency and compassion can make a meaningful difference in the lives of the patients you serve. The Center Medical Director ensures consistency of clinical care delivery, clinician onboarding, as well as supporting market clinical and financial strategies and tactics as determined by the director team. Center Medical Directors have responsibilities of onboarding, coaching, and ensuring that standard workflows are performed and clinical delivery is best in class. Center Hours: Monday-Friday 8a-5p (no off hour call responsiblities) Responsibilities 100% center based providing direct patient care, mentoring, leading by example, and demonstrating clinical excellence and an exceptional patient experience. Assumes role and responsibilities of CMD, whether functioning in the capacity of a CMD at a specific location or in the capacity of the Market Float providing coverage for an open CMD position. Collaborates under Director of Medical Operations (DMO) direction to identify opportunities to improve clinical quality, workflows, safety, center performance, patient and client experience and satisfaction metrics, or other facets of the practice. Works with director team (primarily Director of Medical Operations, DMO and Director of Therapy Operations, DTO) to identify clinical improvement opportunities and ensure appropriate support and workflow compliance that foster an environment optimal for patient care. Mentors and trains future clinical leaders as well as newly hired and tenured clinicians. Fosters an environment of collaboration, professionalism, patient/colleague safety, quality care, continuous improvement and reward and recognition. Understands center financial drivers and outcomes, along with available tools in order to achieve annual business and strategic plans. Assists CMD's to understand same. Maintains and leverages relationships with employers, payers, referral sources, networks, and local communities to drive market growth. Responds to requests and issues within 24 hours. Assists with the planning of clinician meetings, leads, or assists in conducting Assists DMO and EA in managing staffing in centers and adjustments for unforeseen coverage needs May be required to observe drug/alcohol testing of patients This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Qualifications Board Certified in Occupational Medicine, Emergency Medicine, Family Medicine, Internal Medicine, or Physiatry related from ABMS or AOA Current unrestricted medical license in state of Ohio as required for clinical and/or business duties Unrestricted DEA registration in Ohio CMS/Medicare enrollment Medical degree (MD) or Doctor of Osteopathy (DO) degree from accredited institution DOT FMCSA certification (current or willing to get during credentialing process) Job-Related Experience Preferred two years' directly applicable experience including relevant clinical and supervisory experience for clinical scope Preferred two years' experience in managed care and physician management. Experience developing and leading medical management and quality improvement programs, preferably in a managed care setting. Job-Related Skills/Competencies Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies Agrees, supports, and commits to Concentra's core practice standards and Policies and Procedures Excellent communication skills including speaking, presentation, listening, telephone, negotiation, business, and medical writing skills necessary to convey information to supervisors, peers, or customers Demonstrate a high level of skill with interpersonal relationships and communications. Working knowledge of Human Resource principles and practices of personnel recruitment, selection, coaching and other aspects of performance management Proven ability to effectively supervise other professionals Skilled in reviewing the clinical work of others according to professional standards and practice guidelines Ability to supervise, evaluate, coach, and develop staff Fosters a cooperative and harmonious working climate conducive to maximize employee morale and productivity Ability to “put patients first” and enjoys treating patients Superior patient/customer service and “bed side manner” skills Must be a team player in a multidisciplinary environment Demonstrates a value of all contributions to product and outcome Displays a professional, approachable, and selfless demeanor (no arrogance) at all times both to external and internal clients Ability to display high degree of inspiration for team members to retain focus of providing highest levels of customer satisfaction Willingness to learn and continuously improve, to be audited, observed, and reviewed; is positively responsive to feedback
$165k-242k yearly est. 3d ago
Medical Director Oncology UM - Remote anywhere in US
Unitedhealth Group 4.6
Portland, OR jobs
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** . The Medical Director Oncology will provide utilization review determinations and support case and disease management teams to achieve optimal clinical outcomes. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Perform utilization review determinations for oncology populations, and support case and disease management teams to achieve optimal clinical outcomes + Serve as a subject matter expert in evidence - based oncology guidelines, especially those produced by the National Comprehensive Cancer Network (NCCN), and help ensure all clinically relevant policies and processes are informed by the best available evidence + Engage and collaborate with treating providers telephonically; This will include discussion of evidence-based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expense + Enhance clinical expertise of the Oncology team through education sessions with nursing teams, and serving as a thought leader and point of contact for relevant medical societies and stakeholders + Evaluate clinical and other data (e.g., quality metrics, claims and health record data, utilization data) to identify opportunities for improvement of clinical care and processes + Collaborate with operational and business partners on enterprise-wide research and clinical and quality initiatives to enhance Optum impact in the oncology field You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + MD or DO with an active, unrestricted medical license + Obtain additional licenses as needed + Current Board Certification in an ABMS or AOBMS specialty in Oncology + 5+ years of clinical practice experience (inclusive of Medical Oncology) + Experience working with NCCN guidelines + Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, case management, disease management, quality management, product development, and/or peer review + Participate in rotational holiday and call coverage **Preferred Qualification:** + Experience in managed care and quality management *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The salary range for this role is $238,000 to $357,500 annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 60d+ ago
Medical Director - Outpatient Clinical Review - Remote
Unitedhealth Group 4.6
Seattle, WA jobs
**Optum is seeking a Medical Director for** **utilization management review** **to join our team. Optum is a clinician-led care organization that is changing the way clinicians work and live.** As a member of the Optum Care Delivery team, you'll be an integral part of Optum's vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while **Caring. Connecting. Growing together.** You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Work to improve quality and promote evidence-based medicine through outpatient utilization management review + Work with medical director teams focusing on outpatient and inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review + Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement + Support initiatives that enhance quality throughout our national network + Ensure the right service is provided at the right time for each member + Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + MD or DO degree + Active, unrestricted physician license + Current board certification in ABMS or AOA specialty + 5+ years of clinical practice experience post residency + Solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles **Preferred Qualifications:** + Hands-on utilization and/or quality management experience + Project management or active project participation experience + Substantial experience in using electronic clinical systems + Active, unrestricted physician California state license The scope of this role will include Prior Authorization for Medicare Advantage members focusing on high value procedures such as Myocardial SPECT, PET scans, DME/Home Ventilator, Genetic Testing, and many more. Additionally, the team handles UM functions for the Arizona and New Mexico markets. **What makes and Optum organization different?** + Be part of a best-in-class employee experience that enables you to practice at the top of your license + We believe that better care for clinicians equates to better care for patients + We are influencing change collectively on a national scale while still maintaining the culture and community of our local care organizations + Practice medicine autonomously, with the support, not restrictions, of a sustainable and thriving national health care organization **Compensation & Benefits Highlights** + Guaranteed, competitive compensation model based on quality, not quantity, with significant earning potential, annual increases, and bonus eligibility + Financial stability and support of a Fortune 5 Company + Robust retirement offerings including employer funded contributions and Employee Stock Purchase Plan (ESPP for UHG Stock) + Physician and APC Partnership opportunities and incentives + Comprehensive benefits plan inclusive of medical, dental, vision, STD/LTD, CME and malpractice coverage + Robust clinician learning and development programs *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. 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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$248.5k-373k yearly 6d ago
Medical Director Oncology UM - Remote anywhere in US
Unitedhealth Group 4.6
Austin, TX jobs
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** . The Medical Director Oncology will provide utilization review determinations and support case and disease management teams to achieve optimal clinical outcomes. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Perform utilization review determinations for oncology populations, and support case and disease management teams to achieve optimal clinical outcomes + Serve as a subject matter expert in evidence - based oncology guidelines, especially those produced by the National Comprehensive Cancer Network (NCCN), and help ensure all clinically relevant policies and processes are informed by the best available evidence + Engage and collaborate with treating providers telephonically; This will include discussion of evidence-based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expense + Enhance clinical expertise of the Oncology team through education sessions with nursing teams, and serving as a thought leader and point of contact for relevant medical societies and stakeholders + Evaluate clinical and other data (e.g., quality metrics, claims and health record data, utilization data) to identify opportunities for improvement of clinical care and processes + Collaborate with operational and business partners on enterprise-wide research and clinical and quality initiatives to enhance Optum impact in the oncology field You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + MD or DO with an active, unrestricted medical license + Obtain additional licenses as needed + Current Board Certification in an ABMS or AOBMS specialty in Oncology + 5+ years of clinical practice experience (inclusive of Medical Oncology) + Experience working with NCCN guidelines + Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, case management, disease management, quality management, product development, and/or peer review + Participate in rotational holiday and call coverage **Preferred Qualification:** + Experience in managed care and quality management *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The salary range for this role is $238,000 to $357,500 annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 60d+ ago
Medical Director - Post-Acute Care Management - Care Transitions - Remote anywhere in US
Unitedhealth Group 4.6
New York, NY jobs
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. 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. Care Transitions is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions. We do health care differently and we are changing health care one patient at a time. Moreover, have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company's technical vision and strategy. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you 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 as they relate to cost-effective healthcare 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 + Providing intermittent, scheduled weekend and evening coverage + Perform other duties and responsibilities as required, assigned, or requested You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Board certification as an MD, DO, MBBS with a current unrestricted license to practice and willing to maintain necessary credentials to retain the position + Current, unrestricted medical license and the ability to obtain licensure in multiple states + 3+ years of post-residency patient care, preferably in inpatient or post-acute setting **Preferred Qualifications:** + Licensure in multiple states + Willing 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 for this specialty generally ranges from $238,000 - $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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 60d+ ago
Utilization and Clinical Review - Medical Director - Orthopedic Surgery - Remote
Unitedhealth Group 4.6
Minneapolis, MN jobs
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. Position in this function is responsible, in part, as a member of a team of medical directors, for the overall quality, effectiveness and coordination of the medical review services. Additionally, performs Utilization Management reviews and directs/coordinates aspects of the utilization review staff activities, and participates in the Quality Improvement programs for the company. The Medical Director also provides/assists in the direction and oversight in the development and implementation of policies, procedures and clinical criteria for all medical programs and services and may serve as a liaison between physicians, and other medical service providers in selected situations. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: + Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations. The focus of the coverage reviews will be various types of musculoskeletal surgical procedures and other medical/surgical services for musculoskeletal procedures including therapy + Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements. Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers) + Works with clinical staff to coordinate all the necessary coverage reviews and provides feedback to staff who do portions of the coverage reviews + Engage with requesting providers as needed in peer-to-peer discussions + Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews + Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews + Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy + Communicate and collaborate with other internal partners + Call coverage rotation. Is available for periodic weekend and holiday coverage as needed for telephonic and remote computer expedited clinical decisions + Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable + Good understanding of professional performance measurement and related possible discussions/interventions with selected providers/groups/organizations You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + MD or DO with an active, unrestricted medical license + Current, active and unrestricted medical license + Willing to obtain additional licenses as needed + Board Certification in Orthopedic Surgery + 5+ years clinical practice experience post residency + Sound understanding of Evidence Based Medicine (EBM) + Proficient with MS Office (MS Word, Email, Excel, and Power Point) + Proven excellent computer skills and ability to learn new systems and software + Proven excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel **Preferred Qualifications:** + 2+ years managed care, Quality Management experience and/or administrative leadership experience + Experience in utilization and clinical coverage review + Clinical experience within the past 2 years *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $269,500 to $425,500 annually based on full-time employment. We comply with all minimum wage laws as applicable. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$269.5k-425.5k yearly 60d+ ago
Medical Director Oncology UM - Remote anywhere in US
Unitedhealth Group 4.6
Houston, TX jobs
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** . The Medical Director Oncology will provide utilization review determinations and support case and disease management teams to achieve optimal clinical outcomes. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Perform utilization review determinations for oncology populations, and support case and disease management teams to achieve optimal clinical outcomes + Serve as a subject matter expert in evidence - based oncology guidelines, especially those produced by the National Comprehensive Cancer Network (NCCN), and help ensure all clinically relevant policies and processes are informed by the best available evidence + Engage and collaborate with treating providers telephonically; This will include discussion of evidence-based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expense + Enhance clinical expertise of the Oncology team through education sessions with nursing teams, and serving as a thought leader and point of contact for relevant medical societies and stakeholders + Evaluate clinical and other data (e.g., quality metrics, claims and health record data, utilization data) to identify opportunities for improvement of clinical care and processes + Collaborate with operational and business partners on enterprise-wide research and clinical and quality initiatives to enhance Optum impact in the oncology field You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + MD or DO with an active, unrestricted medical license + Obtain additional licenses as needed + Current Board Certification in an ABMS or AOBMS specialty in Oncology + 5+ years of clinical practice experience (inclusive of Medical Oncology) + Experience working with NCCN guidelines + Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, case management, disease management, quality management, product development, and/or peer review + Participate in rotational holiday and call coverage **Preferred Qualification:** + Experience in managed care and quality management *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The salary range for this role is $238,000 to $357,500 annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 60d+ ago
Medical Director, Pharmacy - Remote
Unitedhealth Group 4.6
Nashville, TN jobs
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** The Clinical Coverage Review Medical Director is a key member of the Optum Enterprise Clinical Services Team. On the Focused Pharmacy Review team, they are responsible for providing physician support to Optum Rx Pharmacy Team, and to Clinical Coverage Review (CCR) operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC). The Medical Director collaborates with Optum Rx and CCR leadership and staff to establish, implement, support, and maintain clinical and operational processes related to outpatient pharmacy and medical coverage determinations. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), with a focus on outpatient pharmacy reviews, and on communication regarding this process with both network and non-network physicians, as well as other UnitedHealth Group departments. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. **Primary Responsibilities:** + Review and sign off on proposed pharmacist denials for preservice outpatient medication requests, after review of medical records when provided + Conduct coverage review on some medical cases, based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed in peer-to-peer telephone calls + Use clinical knowledge in the application and interpretation of medical and pharmacy policy and benefit document language in the process of clinical coverage review's guidelines + Conduct daily clinical review and evaluation of all service requests collaboratively with Clinical Coverage Review staff + Provide support for CCR nurses, pharmacists, and non-clinical staff in multiple sites in a manner conducive to teamwork + Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants; educates providers on benefit plans and UHC medical policy + Communicate with and assist Medical Directors outside CCR regarding coverage and other pertinent issues + Communicate and collaborate with other departments such as the Inpatient Concurrent Review team regarding coverage and other issues + Is available and accessible to the CCR staff throughout the day to respond to inquiries. Serve as a clinical resource, coach, and leader within CCR + Access clinical specialty panel to assist or obtain assistance in complex or difficult cases + Document clinical review findings, actions, and outcomes in accordance with CCR policies, and regulatory and accreditation requirements + Actively participate as a key member of the CCR team in regular meetings and projects focused on communication, feedback, problem solving, process improvement, staff training and evaluation and sharing of program results + Actively participate in identifying and resolving problems and collaborates in process improvements that may be outside own team + Provide clinical and strategic leadership when participating on national committees and task forces focused on achieving Clinical Coverage Review goals + Ability to obtain additional state medical licenses as needed + Participate in rotational weekend and holiday call coverage + Other duties and goals assigned by the medical director's supervisor You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Active, unrestricted physician license + Current board certification in Rheumatology, Hematology-Oncology, Internal Medicine, Family Practice or Emergency Medicine + 5+ years of clinical practice experience after completing residency training + Substantial experience in using electronic clinical systems + Proven to participate in rotational weekend and holiday call coverage + Proven solid belief in EBM (Evidence Based Medicine), and familiarity with current medical issues and practices + Proven PC skills, specifically using MS Word, Outlook, and Excel **Preferred Qualifications:** + Clinical practice experience in the last 2 years + Hands-on experience in utilization review + Data analysis experience + Sound knowledge of the managed care industry + Proven data analysis and interpretation experience and skills Proven excellent presentation skills for both clinical and non-clinical audiences + Reside in PST or MST *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy 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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 29d ago
Medical Director, Gastroenterology - Pharmacy - Remote
Unitedhealth Group 4.6
Nashville, TN jobs
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** The Clinical Coverage Review **Medical Director** is a key member of the Optum Enterprise Clinical Services Team. On the Focused **Pharmacy Review** team, they are responsible for providing physician support to Optum Rx Pharmacy Team, and to Clinical Coverage Review (CCR) operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC). The Medical Director collaborates with Optum Rx and CCR leadership and staff to establish, implement, support, and maintain clinical and operational processes related to outpatient pharmacy and medical coverage determinations. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), with a focus on outpatient pharmacy reviews, and on communication regarding this process with both network and non-network physicians, as well as other UnitedHealth Group departments. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Review and sign off on proposed pharmacist denials for preservice outpatient medication requests, after review of medical records when provided + Conduct coverage review on some medical cases, based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed in peer-to-peer telephone calls + Use clinical knowledge in the application and interpretation of medical and pharmacy policy and benefit document language in the process of clinical coverage review's guidelines + Conduct daily clinical review and evaluation of all service requests collaboratively with Clinical Coverage Review staff + Provide support for CCR nurses, pharmacists, and non-clinical staff in multiple sites in a manner conducive to teamwork + Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants; educates providers on benefit plans and UHC medical policy + Communicate with and assist Medical Directors outside CCR regarding coverage and other pertinent issues + Communicate and collaborate with other departments such as the Inpatient Concurrent Review team regarding coverage and other issues + Is available and accessible to the CCR staff throughout the day to respond to inquiries. Serve as a clinical resource, coach, and leader within CCR + Access clinical specialty panel to assist or obtain assistance in complex or difficult cases + Document clinical review findings, actions, and outcomes in accordance with CCR policies, and regulatory and accreditation requirements + Actively participate as a key member of the CCR team in regular meetings and projects focused on communication, feedback, problem solving, process improvement, staff training and evaluation and sharing of program results + Actively participate in identifying and resolving problems and collaborates in process improvements that may be outside own team + Provide clinical and strategic leadership when participating on national committees and task forces focused on achieving Clinical Coverage Review goals + Ability to obtain additional state medical licenses as needed + Participate in rotational weekend and holiday call coverage + Other duties and goals assigned by the medical director's supervisor You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Active, unrestricted physician license + Current board certification in Gastroenterology + 5+ years of clinical practice experience in Gastroenterology after completing residency training + Substantial experience in using electronic clinical systems + Ability to participate in rotational weekend and holiday call coverage + Solid belief in EBM (Evidence Based Medicine), and familiarity with current medical issues and practices + PC skills, specifically using MS Word, Outlook, and Excel **Preferred Qualifications:** + Hands-on experience in utilization review + Clinical practice experience in the last 2 years + Sound knowledge of the managed care industry + Data analysis and interpretation experience and skills + Excellent presentation skills for both clinical and non-clinical audiences *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. 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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 34d ago
UM Medical Director - Radiation Oncologist - Remote in US
Unitedhealth Group 4.6
Dallas, TX jobs
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** The Optum Radiation Oncology Medical Director will provide clinical guidance to help implement a next-generation comprehensive Radiation Oncology solution which will successfully meet clinical, quality, and financial performance objectives. This solution will help ensure providers deliver high-quality, evidence-based and cost-efficient radiation oncology care for our clients. As such, this role requires an innovative, hands-on, action-oriented clinician. This position will serve as a member of the radiation oncology team dedicated to helping ensure high levels of quality, affordability, and member and provider satisfaction. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Perform utilization review determinations for radiation oncology populations, and support case and disease management teams to achieve optimal clinical outcomes + Speak with providers by phone. This will include discussion of evidence-based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expense + Enhance clinical expertise of the radiation oncology team through education sessions with nursing teams, and serving as a thought leader and point of contact for relevant medical societies & stakeholders + Deliver the Optum clinical value proposition focused on quality, affordability and service, in support of the sales and growth activities including conducting client presentations and participating in customer consultations + Evaluate clinical and other data (e.g., quality metrics, claims & health record data, utilization data) to identify opportunities for improvement of clinical care and processes + Collaborate with operational and business partners on enterprise-wide research, clinical and quality initiatives to enhance Optum impact in the Radiation oncology field + This remote-work position will require the use of a company provided personal computer, internet access and familiarity with Microsoft Office applications + Rotational weekend/ holiday on-call coverage as scheduled You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + MD or DO with an active, unrestricted medical license + Current board certification in Radiation Oncology + 5+ years of clinical practice experience (inclusive of radiation oncology) + Proficiency with Microsoft Office applications + Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, case management, disease management, quality management, product development and/or peer review + Proven ability to quickly gain credibility, influence and partner with staff and the clinical community + Participate in rotational weekend/ holiday on-call coverage as scheduled **Preferred Qualifications:** + Experience in managed care, quality management or administrative leadership + Experience working with payer guidelines + Experience in client-facing customer relationship management *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Compensation for this specialty generally ranges from $238,000 - $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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 60d+ ago
Medical Director Utilization Management - Remote
Unitedhealth Group 4.6
Dallas, TX jobs
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs. The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member's primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost-effective quality medical care is provided to members. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations + Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements + Engage with requesting providers as needed in peer-to-peer discussions + Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews + Participate in daily clinical rounds as requested + Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy + Communicate and collaborate with other internal partners + Participate in holiday and call coverage rotation You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + M.D or D.O. + Active board certification in an ABMS or AOBMS specialty + Active unrestricted medical license and ability to obtain additional state medical licenses as needed + 5+ years of clinical practice experience after completing residency training + Proven sound understanding of Evidence Based Medicine (EBM) + Proven solid PC skills, specifically using MS Word, Outlook, and Excel + Ability to participate in rotational holiday and call coverage **Preferred Qualifications:** + Board certification in either Gastroenterology, Cardiology, Endocrinology, radiation oncology (other specialties will be considered) + Experience in utilization and clinical coverage review + Reside in Nebraska or Texas + Proven excellent oral, written, and interpersonal communication skills, facilitation skills + Demonstrated data analysis and interpretation aptitude + Proven innovative problem-solving skills + Demonstrated presentation skills for both clinical and non-clinical audiences *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Compensation for this specialty generally ranges from $238,000 - $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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 60d+ ago
Medical Director - Outpatient Clinical Review - Remote
Unitedhealth Group Inc. 4.6
Los Angeles, CA jobs
Optum is seeking a Medical Director for utilization management review to join our team. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of Optum's vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Work to improve quality and promote evidence-based medicine through outpatient utilization management review * Work with medical director teams focusing on outpatient and inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review * Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement * Support initiatives that enhance quality throughout our national network * Ensure the right service is provided at the right time for each member * Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * MD or DO degree * Active, unrestricted physician license * Current board certification in ABMS or AOA specialty * 5+ years of clinical practice experience post residency * Solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles Preferred Qualifications: * Hands-on utilization and/or quality management experience * Project management or active project participation experience * Substantial experience in using electronic clinical systems * Active, unrestricted physician California state license The scope of this role will include Prior Authorization for Medicare Advantage members focusing on high value procedures such as Myocardial SPECT, PET scans, DME/Home Ventilator, Genetic Testing, and many more. Additionally, the team handles UM functions for the Arizona and New Mexico markets. What makes and Optum organization different? * Be part of a best-in-class employee experience that enables you to practice at the top of your license * We believe that better care for clinicians equates to better care for patients * We are influencing change collectively on a national scale while still maintaining the culture and community of our local care organizations * Practice medicine autonomously, with the support, not restrictions, of a sustainable and thriving national health care organization Compensation & Benefits Highlights * Guaranteed, competitive compensation model based on quality, not quantity, with significant earning potential, annual increases, and bonus eligibility * Financial stability and support of a Fortune 5 Company * Robust retirement offerings including employer funded contributions and Employee Stock Purchase Plan (ESPP for UHG Stock) * Physician and APC Partnership opportunities and incentives * Comprehensive benefits plan inclusive of medical, dental, vision, STD/LTD, CME and malpractice coverage * Robust clinician learning and development programs * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. 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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
$248.5k-373k yearly 6d ago
Medical Director - Post-Acute Care Internist or Physiatrist - Remote in US
Unitedhealth Group Inc. 4.6
Los Angeles, CA jobs
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The Medical Director will partner with cross-functional teams and senior leaders to ensure that Optum leads the industry in innovative health management strategies and is considered an expert in the field of post-acute care. The role as a physician leader, has a proven track record of innovation, achievement of measurable goals, and exceptional clinical competencies. They take a proactive approach to the marketplace and are responsible for continuously reshaping Optum's corporate wide strategies. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Provide daily utilization oversight and external communication with network physicians and hospitals * Daily UM reviews - authorization and denial reviews * Conduct peer to peer conversations for clinical case reviews as needed * Conduct provider telephonic review and discussion, share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care * Communicate effectively with providers to ensure the successful administering of Optum's services * Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers * Collaborate with Team to ensure a coordinated approach toward our member's health care * the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals * Provide leadership and guidance to maximize cost management through close coordination with network and provider contracting * Regularly meet with Optum's 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 Care Management Team to better enhance Optum's 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 * Perform other duties and responsibilities as required, assigned, or requested You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Graduate of a recognized accredited medical school * Current, unrestricted medical license and residency in the United States * Board certified in a recognized ABMS specialty * Board Certified in Internal Medicine, Physiatry or Family Medicine with acute hospital experience * 3+ years of experience practicing in an acute inpatient environment, where dealing with managed care organizations made up at least half of inpatient practice * Proven understanding of population-based medicine with preference given to significant experience with the Medicare, Medicaid, and Commercial populations * Proficient computer skills * Proven working knowledge of changing U.S. payer and provider landscape * Dedicated office/work area established that is separated from other living areas and provides privacy * Reside in a location that can receive a high-speed internet connection Preferred Qualifications: * Demonstrated ability to work with others while completing multiple tasks simultaneously and successfully * Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision * Demonstrated ability to be highly motivated, flexible, and adaptable to working in a fast-paced, dynamic environment * Demonstrated ability to positively interact with other clinicians, senior management, and all levels of medical and non-medical professionals * Demonstrated ability to quickly adapt to change and drive innovation within team and market * Demonstrated ability to work across functions and businesses to achieve business goals * Demonstrated ability to develop and maintain positive customer and provider relationships * Proven solid interpersonal skills and necessary business acumen to communicate and build positive relationships with management * Proven high level of organizational skills, self- motivation, and ability to manage time independently * Proven excellent organizational, verbal, and written communication and presentation skills * Proven excellent analytic skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Compensation for this specialty generally ranges from $248,500.00 - $373,000.00. 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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. OptumCare 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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
$248.5k-373k yearly 8d ago
Inpatient Care Management Medical Director - Remote
Unitedhealth Group 4.6
Chicago, IL jobs
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.** We are currently seeking an Inpatient Care Management Medical Director to join our Optum team. This team is responsible for conducting acute level of care and length of stay reviews for medical necessity for our members being managed within the continuum of care. Our clients include local and national commercial employer, Medicare, and state Medicaid plans. The Medical Directors work with groups of nurses and support staff to manage inpatient care utilization at a hospital, market, regional or national level. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Participate in telephonic outreach for collaboration with treating providers. This will include discussion of evidence - based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expenses + Responsible to collaborate with operational and business partners on clinical and quality initiatives at the site and customer level to address customer expectations + Is grounded in the use and application of evidence-based medicine (EBM) such as InterQual care guidelines and criteria review + Occasionally, may participate in periodic market oversight meetings with the outward facing Chief Medical Officers, network contractors, nurse management and other internal managers + Participate in rotational holiday and call coverage + Maintain proficiency in all required software and platforms Although the Optum ICM Medical Director's work is typically concentrated in a region, they are part of a national organization and team, and collaborate with peers, nurse managers, and non-clinical employees from across the country. In response to customer needs and expectations, Optum is continuously modifying its programs and approaches. Although not a primary job function, Medical Directors with the interest in doing so often can be involved with change design and management. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + MD or DO with an active, unrestricted medical license + Current Board Certification in an ABMS or AOA specialty + 3+ years of clinical practice experience post residency + Technical proficiency in computer software and systems + Private home office and access to high-speed Internet + Participate in rotational holiday and call coverage **Preferred Qualifications:** + 2+ years of managed care, Quality Management experience and/or administrative leadership experience + Prior UM experience + Clinical experience within the past 2 years *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Compensation for this specialty generally ranges from $248,500.00 to $373,000. 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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$248.5k-373k yearly 8d ago
UM Medical Director - Radiation Oncologist - Remote in US
Unitedhealth Group 4.6
Philadelphia, PA jobs
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** The Optum Radiation Oncology Medical Director will provide clinical guidance to help implement a next-generation comprehensive Radiation Oncology solution which will successfully meet clinical, quality, and financial performance objectives. This solution will help ensure providers deliver high-quality, evidence-based and cost-efficient radiation oncology care for our clients. As such, this role requires an innovative, hands-on, action-oriented clinician. This position will serve as a member of the radiation oncology team dedicated to helping ensure high levels of quality, affordability, and member and provider satisfaction. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Perform utilization review determinations for radiation oncology populations, and support case and disease management teams to achieve optimal clinical outcomes + Speak with providers by phone. This will include discussion of evidence-based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expense + Enhance clinical expertise of the radiation oncology team through education sessions with nursing teams, and serving as a thought leader and point of contact for relevant medical societies & stakeholders + Deliver the Optum clinical value proposition focused on quality, affordability and service, in support of the sales and growth activities including conducting client presentations and participating in customer consultations + Evaluate clinical and other data (e.g., quality metrics, claims & health record data, utilization data) to identify opportunities for improvement of clinical care and processes + Collaborate with operational and business partners on enterprise-wide research, clinical and quality initiatives to enhance Optum impact in the Radiation oncology field + This remote-work position will require the use of a company provided personal computer, internet access and familiarity with Microsoft Office applications + Rotational weekend/ holiday on-call coverage as scheduled You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + MD or DO with an active, unrestricted medical license + Current board certification in Radiation Oncology + 5+ years of clinical practice experience (inclusive of radiation oncology) + Proficiency with Microsoft Office applications + Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, case management, disease management, quality management, product development and/or peer review + Proven ability to quickly gain credibility, influence and partner with staff and the clinical community + Participate in rotational weekend/ holiday on-call coverage as scheduled **Preferred Qualifications:** + Experience in managed care, quality management or administrative leadership + Experience working with payer guidelines + Experience in client-facing customer relationship management *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Compensation for this specialty generally ranges from $238,000 - $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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 60d+ ago
Medical Director - Pain Management Specialist - Remote
Unitedhealth Group 4.6
Chicago, IL jobs
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together** . Responsible, in part, as a member of a team of medical directors, for the overall quality, effectiveness and coordination of the medical review services. Additionally, performs Utilization Management reviews and directs/coordinates aspects of the utilization review staff activities, and participates in the Quality Improvement programs for the company. The Medical Director also provides/assists in the direction and oversight in the development and implementation of policies, procedures and clinical criteria for all medical programs and services and may serve as a liaison between physicians, and other medical service providers in selected situations. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations. The focus of the coverage reviews will be various types of musculoskeletal and other medical/surgical services which will include prior authorizations for Pain Management procedures ( e.g. spinal chord stimulators, pain pumps, nerve ablations, facet injections, etc.) + Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements. Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers) + Works with clinical staff to coordinate all the necessary UM processes and provides feedback to staff who do portions of the UM reviews + Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable + Discusses cases and clinical situations with treating providers telephonically during scheduled hours + Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews + Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews + Participate in rotational call coverage. Is available for occasional, periodic weekend and holiday as needed telephonic and remote computer expedited clinical decisions + Provide Clinical support for staff that conduct initial reviews + Good understanding of professional performance measurement and related possible discussions/interventions with selected providers/groups/organizations You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Current, active, and fully unrestricted medical license + Current Board Certification and must maintain pain subspecialty with specialty in either PM&R or Anesthesia + 5+ years clinical experience post residency in Pain subspecialty + Proficient with MS Office (MS Word, Email, Excel, and Power Point) + Excellent computer skills and ability to learn new systems and software + Excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel + Participate in rotational call coverage + Must be willing and able to obtain additional medical licenses as needed **Preferred Qualifications:** + License in North Carolina or New Mexico a plus + Experience in managed care UM activities + Must possess leadership skills in working with other physicians, knowledge of the overall medical community and the local / regional managed care environments + Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy 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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 60d+ ago
Appeals Medical Director - General Medicine - Required - Remote
Unitedhealth Group 4.6
Chicago, IL jobs
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together** The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. **Primary Responsibilities:** + Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies + Perform Department of Insurance/Department of Managed Healthcare, and CMS regulatory responses + Communicate with UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretations + Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues + Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results + Provide clinical and strategic input when participating in organizational committees, projects, and task forces You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + MD or DO with an active, unrestricted license + Board Certified in an ABMS or AOBMS specialty + 5+ years of clinical practice experience + 2+ years of Quality Management experience + Demonstrated intermediate or higher level of proficiency with managed care + Proven excellent telephonic communication skills; excellent interpersonal communication skills + Proven excellent project management skills + Proven data analysis and interpretation skills + Proven excellent presentation skills for both clinical and non-clinical audiences + Demonstrated familiarity with current medical issues and practices + Proven creative problem-solving skills + Demonstrated basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills + Demonstrated solid team player and team building skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Compensation for this specialty generally ranges from $238,000 - $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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 60d+ ago
Medical Claims Review Medical Director - Urology - Remote
Unitedhealth Group Inc. 4.6
Eden Prairie, MN jobs
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Here at Optum, we have an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs. The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on post-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member's primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost effective quality medical care is provided to members. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations * Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements * Engage with requesting providers as needed in peer-to-peer discussions * Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews * Participate in daily clinical rounds as requested * Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy * Communicate and collaborate with other internal partners You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * M.D. or D.O. * Active unrestricted medical license and ability to obtain additional state medical licenses as needed * Board certification in Urology * 5+ years of clinical practice experience after completing residency training * Proven sound understanding of Evidence Based Medicine (EBM) * Demonstrated PC skills, specifically using MS Word, Outlook, and Excel Preferred Qualifications: * Texas or California License * Compact License * Experience in utilization review * Reside in PST, or MST * Demonstrated data analysis and interpretation aptitude * Proven innovative problem-solving skills * Proven excellent presentation skills for both clinical and non-clinical audiences * Demonstrated excellent oral, written, and interpersonal communication skills, facilitation skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Compensation for this specialty generally ranges from $248,500 - $373,000. 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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
$248.5k-373k yearly 8d ago
UM Medical Director - Orthopedic Spine, Neurosurgery or Spine Surgery - Remote
Unitedhealth Group 4.6
Eden Prairie, MN jobs
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.** Position in this function is responsible, in part, as a member of a team of medical directors, for the overall quality, effectiveness and coordination of the medical review services. Additionally, performs Utilization Management reviews and directs/coordinates aspects of the utilization review staff activities, and participates in the Quality Improvement programs for the company. The Medical Director also provides/assists in the direction and oversight in the development and implementation of policies, procedures and clinical criteria for all medical programs and services and may serve as a liaison between physicians, and other medical service providers in selected situations. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations. The focus of the coverage reviews will be various types of musculoskeletal and other medical/surgical services which will include prior authorizations for spine surgery + Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements. Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers) + Works with clinical staff to coordinate all the necessary coverage reviews and provides feedback to staff who do portions of the coverage reviews + Engage with requesting providers as needed in peer-to-peer discussions + Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews + Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews + Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy + Communicate and collaborate with other internal partners + Call coverage rotation. Is available for periodic weekend and holiday coverage as needed for telephonic and remote computer expedited clinical decisions + Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable + Good understanding of professional performance measurement and related possible discussions/interventions with selected providers/groups/organizations You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Current, active and unrestricted medical license + Current Board Certification in Orthopedic Surgery or Neurosurgery + 5+ years clinical experience post residency in Orthopedic Surgery or Neurosurgery to include experience with musculoskeletal/ spine surgery + Sound understanding of Evidence Based Medicine (EBM) + Proficient with MS Office (MS Word, Email, Excel, and Power Point) + Excellent computer skills and ability to learn new systems and software + Excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel + Willing to obtain additional licenses as needed **Preferred Qualifications:** + Active license in South Carolina, Minnesota or Texas, but candidates with an active license in other states are acceptable + ABMS or other nationally recognized further specialized certifications + Experience in managed care UM activities/ coverage reviews + Possess leadership skills in working with other physicians, knowledge of the overall medical community and the local / regional managed care environments + Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy 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. We comply with all minimum wage laws as applicable. 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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 believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 60d+ ago