Medical Director jobs at Humana

Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management. Medical Use your skills to make an impact Responsibilities The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of mentored training, daily work is performed with minimal direction. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Required Qualifications MD or DO degree 4 x 10h (Fri, Sat, Sun, Mon) 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). Current and ongoing Board Certification an approved ABMS Medical Specialty A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. Excellent verbal and written communication skills . Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation. Preferred Qualifications Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management. Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. Experience with national guidelines such as MCG or InterQual Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists Advanced degree such as an MBA, MHA, MPH Exposure to Public Health, Population Health, analytics, and use of business metrics. Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. The curiosity to learn, the flexibility to adapt and the courage to innovate Additional Information Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees. #physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 04-30-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Do you crave an intellectually stimulating job that allows you to leverage your clinical expertise while developing new skills and improving the lives of others? Then look no further! As a Medical Oncology Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you'll use your clinical know-how to provide evidence-based medical reviews for patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you'll make a difference: You'll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore's case management software. Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence-based medical necessity and appropriateness of the requested service or treatment. Leverage your clinical expertise to recommend alternative services or treatments as necessary. Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. What you'll enjoy about working here: Benefits start on day one Predictable work schedules 100% work from home 8 Paid Holidays + 23 PTO Days 401(K) with company match Reimbursement for continuing medical education Career growth opportunities across the enterprise Networking with peers across multiple medical specialties Requirements: M.D. or D.O. with a current, active, U.S. state medical license and board certified in Medical Oncology, recognized by the American Board of Medical Specialties, or American Osteopathic Association Eligible to acquire additional state licensure as required 3 years of relevant clinical experience post residency/fellowship Knowledge of applicable state federal laws Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus Ability to commit to a set, weekly work schedule (Monday through Friday) Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

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 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. This Behavioral Medical Director offers a unique combination of responsibilities and opportunities. The MD will be the Chief Behavioral Medical Officer for a government program MCO serving roughly 50K individuals. As a member of the Executive Leadership Team, the MD will be the primary behavioral representative for clinical activities, quality improvement, utilization management and integrity, compliance, governmental relations, and policy. The MD will work collaboratively with a behavioral team consisting of an Executive Director, Operations/Clinical Director, dedicated UM and CM professionals, as well as other corporate supports. The MD will be a Population Health thought and innovation leader working with peers from other MCOs, State Government, and the Community. While the MD will support UM, it will be done in collaboration with a larger group of physician peers from our Western Region. Secondly, the MD is aligned with a group of Psychiatrists offering clinical oversight and direction to Optum's Clinical team. As a team member, the Behavioral Health Medical Director will collaborate cross-functionally with other Optum and UHG partners to design, build and test clinical models to drive better outcomes and affordability for members with complex needs including those with substance use disorders, behavioral and medical health conditions, and unmet social determinants of health, with a vision to improve member engagement in clinically, cost-effective care. The Behavioral Medical Director is responsible for providing clinical oversight to medical-behavioral integrated (MBI) multidisciplinary teams working to engage members in their recovery. This team uses data and performance metrics to design prototypes assessing interventions, stratification and impact, cost, provider performance, and value creation. This individual will interact directly with and offer clinical, procedural, or administrative recommendations to psychiatrists and other behavioral health providers, medical physicians and nurses, clinical professionals, and/or state agencies caring for our community. The Behavioral Medical Director is part of a leadership team managing development and implementation of affordable, evidence-based treatments and regional action planning, and advises leadership on health care system improvement opportunities. Case Management activities include utilization management, case consultation, participation in MBI activities, care engagement-clinical rounds, collaboration with, and participation in the development of case management innovation and evolution. The Behavioral Medical Director participates in quality activities to measure value and promote best practices, including reviewing procedures affecting the quality of care for our members. The Behavioral Medical Director reports directly to the Senior Medical Director for the West region. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Ensuring delivery of cost-effective quality care that incorporates evidence-based practices, recovery, resiliency, and person-centered services * Coordination with multiple medical specialties including behavioral, community-based clinicians, specialists, general practitioners, state agencies, and other stakeholders involved in the implementation of a longitudinal care plan * Works as part of an integrated medical-behavioral team that helps coordinate care engagement, care coordination and MBI activities * Provide clinical supervision to the clinical staff, oversee the management of services at all levels of care in the benefit plan * Keep current regarding Evidence Based Practices and treatment philosophies including those that address MBI, equity, trauma-informed care, recovery, and resilience * Maintaining the clinical integrity of the program, including timely peer reviews, documentation, and consultations * Work collaboratively with the Health Plan Executive Leadership Team * Increase interaction, policy making and advocacy with our state partner * Develop collaborative clinical and value-based partnerships w/ providers 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: * Doctor of Medicine or Osteopathy * Current license to practice as a physician without restrictions in the state of New Mexico * Currently reside in New Mexico * Board certified in Psychiatry * Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management * Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation, and recovery * Computer and typing proficiency, data analysis and organizational skills * Ability to participate in rotational weekend call coverage Preferred Qualifications: * Board certification in Child and Adolescent Psychiatry; Addiction experience/training * 3+ years of experience as a practicing psychiatrist post residency * Managed care experience * Experience in public sector delivery systems and experience in state specific public sector services * Experience working with community-based programs and resources designed to aid the State Medicaid population * 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 $258,000 to $423,000 annually based on full-time employment. This role is also eligible to receive bonuses based on sales performance. We comply with all minimum wage laws as applicable. 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.

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. If you reside in Florida, you will have the flexibility to work remotely* 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:** + Doctor of Medicine or Osteopathy + Current active, unrestricted license to practice as a physician without restrictions in the state of FL + Current board certification in Internal Medicine or Family Practice + 5+ years of clinical practice experience after completing residency training + Substantial experience in using electronic clinical systems + Solid belief in EBM (Evidence Based Medicine), and familiarity with current medical issues and practices + PC skills, specifically using MS Word, Outlook, and Excel + Ability to participate in rotational weekend and holiday call coverage + Currently reside in Florida **Preferred Qualifications:** + Hands-on experience in utilization review + Clinical practice experience in the last 2 years + Data analysis experience + Data analysis and interpretation experience and skills + Sound knowledge of the managed care industry + Proven 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 - $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._

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. If you reside in Florida, you will have the flexibility to work remotely* 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: * Doctor of Medicine or Osteopathy * Current active, unrestricted license to practice as a physician without restrictions in the state of FL * Current board certification in Internal Medicine or Family Practice * 5+ years of clinical practice experience after completing residency training * Substantial experience in using electronic clinical systems * Solid belief in EBM (Evidence Based Medicine), and familiarity with current medical issues and practices * PC skills, specifically using MS Word, Outlook, and Excel * Ability to participate in rotational weekend and holiday call coverage * Currently reside in Florida Preferred Qualifications: * Hands-on experience in utilization review * Clinical practice experience in the last 2 years * Data analysis experience * Data analysis and interpretation experience and skills * Sound knowledge of the managed care industry * Proven 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 - $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.

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. If you reside in Florida, you will have the flexibility to work remotely* 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:** + Doctor of Medicine or Osteopathy + Current active, unrestricted license to practice as a physician without restrictions in the state of FL + Current board certification in Internal Medicine or Family Practice + 5+ years of clinical practice experience after completing residency training + Substantial experience in using electronic clinical systems + Solid belief in EBM (Evidence Based Medicine), and familiarity with current medical issues and practices + PC skills, specifically using MS Word, Outlook, and Excel + Ability to participate in rotational weekend and holiday call coverage + Currently reside in Florida **Preferred Qualifications:** + Hands-on experience in utilization review + Clinical practice experience in the last 2 years + Data analysis experience + Data analysis and interpretation experience and skills + Sound knowledge of the managed care industry + Proven 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 - $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._

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 Behavioral Medical Director is responsible for overseeing and guiding the Utilization Management team. This individual will interact directly with Psychiatrists, Behavioral Health Providers, and other clinical professionals, such as Psychiatric Nurses, who consult on various complex clinical scenarios, processes and programs. The Behavioral Medical Director is part of a team that manages development and implementation of evidence-based treatments and medical expense initiatives and will also advise leadership on system improvement opportunities. They are responsible for timely peer reviews, appeals and consultations with providers and other community-based clinicians, including general practitioners, and will work collaboratively with utilization management, care management, quality, account management, and operations teams. 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: * Ensuring delivery of cost-effective quality care that incorporates recovery, resiliency, and person-centered services * Implementation of Level of Care guidelines and Utilization Management protocols * Provide clinical oversight and support to the clinical staff, oversee the management of services at all levels of care in the benefit plan * Keep current regarding Evidence Based Practices and treatment philosophies including those that address Recovery and Resilience The Behavioral Medical Director will support: * Clinical review and oversight of behavioral health cases in collaboration with multidisciplinary team members * Peer-to-peer consultations * Compliance with state regulations and licensure * Quality assurance and audit readiness for accreditation 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: * Doctor of Medicine or Osteopathy * Current license to practice as a physician without restrictions and willing to maintain necessary credentials to retain the position * Board certified in Psychiatry and willing to maintain credentials * Experience working in a multidisciplinary clinical team * Knowledge of post-discharge care planning such as home care, discharge planning, care management, and disease management * Computer and typing proficiency, data analysis, and organizational skills * Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non-medical professionals * Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation, and recovery * Demonstrated competence in use of electronic health records as well as associated technology and applications * Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues * Participate in rotational holiday and call coverage Preferred Qualifications: * Board certification in Child and Adolescent Psychiatry or Addiction Medicine * 3+ years of experience as a practicing psychiatrist post residency * Managed care experience to include familiarity with Utilization Management guidelines * Familiar with behavioral services within the NY, NJ, CT Tri-State area; to include active licensure * Understanding of Medical Behavioral Integration and Whole Person Care concepts and application * Willing to obtain additional state licensure, with support * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Compensation for this specialty generally ranges from $258,000 to $423,000. 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.

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. If you reside in Florida, you will have the flexibility to work remotely* 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:** + Doctor of Medicine or Osteopathy + Current active, unrestricted license to practice as a physician without restrictions in the state of FL + Current board certification in Internal Medicine or Family Practice + 5+ years of clinical practice experience after completing residency training + Substantial experience in using electronic clinical systems + Solid belief in EBM (Evidence Based Medicine), and familiarity with current medical issues and practices + PC skills, specifically using MS Word, Outlook, and Excel + Ability to participate in rotational weekend and holiday call coverage + Currently reside in Florida **Preferred Qualifications:** + Hands-on experience in utilization review + Clinical practice experience in the last 2 years + Data analysis experience + Data analysis and interpretation experience and skills + Sound knowledge of the managed care industry + Proven 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 - $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._

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. If you reside in Florida, you will have the flexibility to work remotely* 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:** + Doctor of Medicine or Osteopathy + Current active, unrestricted license to practice as a physician without restrictions in the state of FL + Current board certification in Internal Medicine or Family Practice + 5+ years of clinical practice experience after completing residency training + Substantial experience in using electronic clinical systems + Solid belief in EBM (Evidence Based Medicine), and familiarity with current medical issues and practices + PC skills, specifically using MS Word, Outlook, and Excel + Ability to participate in rotational weekend and holiday call coverage + Currently reside in Florida **Preferred Qualifications:** + Hands-on experience in utilization review + Clinical practice experience in the last 2 years + Data analysis experience + Data analysis and interpretation experience and skills + Sound knowledge of the managed care industry + Proven 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 - $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._

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. 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: * 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 * 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 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 license to practice medicine * Board certification in an ABMS specialty with Internal Medicine, Family Medicine, Hematology - Oncology, General Surgery, ENT, Rheumatology, or PM&R preferred * 3+ years of clinical practice experience after completing residency training * Demonstrated sound understanding of Evidence Based Medicine (EBM) * Proven solid PC skills, specifically using MS Word, Outlook, and Excel Preferred Qualifications: * CA, OR, WA or AZ licensure or willing to obtain * Experience in utilization and clinical coverage review * Proven excellent oral, written, and interpersonal communication skills, facilitation skills * Proven data analysis and interpretation aptitude * Proven innovative problem-solving skills * Proven 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 - $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.

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. If you reside in Florida, you will have the flexibility to work remotely* 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:** + Doctor of Medicine or Osteopathy + Current active, unrestricted license to practice as a physician without restrictions in the state of FL + Current board certification in Internal Medicine or Family Practice + 5+ years of clinical practice experience after completing residency training + Substantial experience in using electronic clinical systems + Solid belief in EBM (Evidence Based Medicine), and familiarity with current medical issues and practices + PC skills, specifically using MS Word, Outlook, and Excel + Ability to participate in rotational weekend and holiday call coverage + Currently reside in Florida **Preferred Qualifications:** + Hands-on experience in utilization review + Clinical practice experience in the last 2 years + Data analysis experience + Data analysis and interpretation experience and skills + Sound knowledge of the managed care industry + Proven 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 - $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._

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 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.** This Behavioral Medical Director offers a unique combination of responsibilities and opportunities. The MD will be the Chief Behavioral Medical Officer for a government program MCO serving roughly 50K individuals. As a member of the Executive Leadership Team, the MD will be the primary behavioral representative for clinical activities, quality improvement, utilization management and integrity, compliance, governmental relations, and policy. The MD will work collaboratively with a behavioral team consisting of an Executive Director, Operations/Clinical Director, dedicated UM and CM professionals, as well as other corporate supports. The MD will be a Population Health thought and innovation leader working with peers from other MCOs, State Government, and the Community. While the MD will support UM, it will be done in collaboration with a larger group of physician peers from our Western Region. Secondly, the MD is aligned with a group of Psychiatrists offering clinical oversight and direction to Optum's Clinical team. As a team member, the Behavioral Health Medical Director will collaborate cross-functionally with other Optum and UHG partners to design, build and test clinical models to drive better outcomes and affordability for members with complex needs including those with substance use disorders, behavioral and medical health conditions, and unmet social determinants of health, with a vision to improve member engagement in clinically, cost-effective care. The Behavioral Medical Director is responsible for providing clinical oversight to medical-behavioral integrated (MBI) multidisciplinary teams working to engage members in their recovery. This team uses data and performance metrics to design prototypes assessing interventions, stratification and impact, cost, provider performance, and value creation. This individual will interact directly with and offer clinical, procedural, or administrative recommendations to psychiatrists and other behavioral health providers, medical physicians and nurses, clinical professionals, and/or state agencies caring for our community. The Behavioral Medical Director is part of a leadership team managing development and implementation of affordable, evidence-based treatments and regional action planning, and advises leadership on health care system improvement opportunities. Case Management activities include utilization management, case consultation, participation in MBI activities, care engagement-clinical rounds, collaboration with, and participation in the development of case management innovation and evolution. The Behavioral Medical Director participates in quality activities to measure value and promote best practices, including reviewing procedures affecting the quality of care for our members. The Behavioral Medical Director reports directly to the Senior Medical Director for the West region. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Ensuring delivery of cost-effective quality care that incorporates evidence-based practices, recovery, resiliency, and person-centered services + Coordination with multiple medical specialties including behavioral, community-based clinicians, specialists, general practitioners, state agencies, and other stakeholders involved in the implementation of a longitudinal care plan + Works as part of an integrated medical-behavioral team that helps coordinate care engagement, care coordination and MBI activities + Provide clinical supervision to the clinical staff, oversee the management of services at all levels of care in the benefit plan + Keep current regarding Evidence Based Practices and treatment philosophies including those that address MBI, equity, trauma-informed care, recovery, and resilience + Maintaining the clinical integrity of the program, including timely peer reviews, documentation, and consultations + Work collaboratively with the Health Plan Executive Leadership Team + Increase interaction, policy making and advocacy with our state partner + Develop collaborative clinical and value-based partnerships w/ providers 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:** + Doctor of Medicine or Osteopathy + Current license to practice as a physician without restrictions in the state of New Mexico + Currently reside in New Mexico + Board certified in Psychiatry + Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management + Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation, and recovery + Computer and typing proficiency, data analysis and organizational skills + Ability to participate in rotational weekend call coverage **Preferred Qualifications:** + Board certification in Child and Adolescent Psychiatry; Addiction experience/training + 3+ years of experience as a practicing psychiatrist post residency + Managed care experience + Experience in public sector delivery systems and experience in state specific public sector services + Experience working with community-based programs and resources designed to aid the State Medicaid population *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 $258,000 to $423,000 annually based on full-time employment. This role is also eligible to receive bonuses based on sales performance. We comply with all minimum wage laws as applicable. **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._

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our navi Health product, we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home. We're connecting care to create a seamless health journey for patients across care settings. Join us to start **Caring. Connecting. Growing together.** **Why navi Health?** At navi Health, 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. navi Health 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 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 **California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington** **or** **Washington, D.C. Residents Only:** The salary range for this role is $286,104 to $397,743 annually. 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 local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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._ _Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

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 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.** This Behavioral Medical Director offers a unique combination of responsibilities and opportunities. The MD will be the Chief Behavioral Medical Officer for a government program MCO serving roughly 50K individuals. As a member of the Executive Leadership Team, the MD will be the primary behavioral representative for clinical activities, quality improvement, utilization management and integrity, compliance, governmental relations, and policy. The MD will work collaboratively with a behavioral team consisting of an Executive Director, Operations/Clinical Director, dedicated UM and CM professionals, as well as other corporate supports. The MD will be a Population Health thought and innovation leader working with peers from other MCOs, State Government, and the Community. While the MD will support UM, it will be done in collaboration with a larger group of physician peers from our Western Region. Secondly, the MD is aligned with a group of Psychiatrists offering clinical oversight and direction to Optum's Clinical team. As a team member, the Behavioral Health Medical Director will collaborate cross-functionally with other Optum and UHG partners to design, build and test clinical models to drive better outcomes and affordability for members with complex needs including those with substance use disorders, behavioral and medical health conditions, and unmet social determinants of health, with a vision to improve member engagement in clinically, cost-effective care. The Behavioral Medical Director is responsible for providing clinical oversight to medical-behavioral integrated (MBI) multidisciplinary teams working to engage members in their recovery. This team uses data and performance metrics to design prototypes assessing interventions, stratification and impact, cost, provider performance, and value creation. This individual will interact directly with and offer clinical, procedural, or administrative recommendations to psychiatrists and other behavioral health providers, medical physicians and nurses, clinical professionals, and/or state agencies caring for our community. The Behavioral Medical Director is part of a leadership team managing development and implementation of affordable, evidence-based treatments and regional action planning, and advises leadership on health care system improvement opportunities. Case Management activities include utilization management, case consultation, participation in MBI activities, care engagement-clinical rounds, collaboration with, and participation in the development of case management innovation and evolution. The Behavioral Medical Director participates in quality activities to measure value and promote best practices, including reviewing procedures affecting the quality of care for our members. The Behavioral Medical Director reports directly to the Senior Medical Director for the West region. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Ensuring delivery of cost-effective quality care that incorporates evidence-based practices, recovery, resiliency, and person-centered services + Coordination with multiple medical specialties including behavioral, community-based clinicians, specialists, general practitioners, state agencies, and other stakeholders involved in the implementation of a longitudinal care plan + Works as part of an integrated medical-behavioral team that helps coordinate care engagement, care coordination and MBI activities + Provide clinical supervision to the clinical staff, oversee the management of services at all levels of care in the benefit plan + Keep current regarding Evidence Based Practices and treatment philosophies including those that address MBI, equity, trauma-informed care, recovery, and resilience + Maintaining the clinical integrity of the program, including timely peer reviews, documentation, and consultations + Work collaboratively with the Health Plan Executive Leadership Team + Increase interaction, policy making and advocacy with our state partner + Develop collaborative clinical and value-based partnerships w/ providers 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:** + Doctor of Medicine or Osteopathy + Current license to practice as a physician without restrictions in the state of New Mexico + Currently reside in New Mexico + Board certified in Psychiatry + Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management + Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation, and recovery + Computer and typing proficiency, data analysis and organizational skills + Ability to participate in rotational weekend call coverage **Preferred Qualifications:** + Board certification in Child and Adolescent Psychiatry; Addiction experience/training + 3+ years of experience as a practicing psychiatrist post residency + Managed care experience + Experience in public sector delivery systems and experience in state specific public sector services + Experience working with community-based programs and resources designed to aid the State Medicaid population *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 $258,000 to $423,000 annually based on full-time employment. This role is also eligible to receive bonuses based on sales performance. We comply with all minimum wage laws as applicable. **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._

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._

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._

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.

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._

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 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.** This Behavioral Medical Director offers a unique combination of responsibilities and opportunities. The MD will be the Chief Behavioral Medical Officer for a government program MCO serving roughly 50K individuals. As a member of the Executive Leadership Team, the MD will be the primary behavioral representative for clinical activities, quality improvement, utilization management and integrity, compliance, governmental relations, and policy. The MD will work collaboratively with a behavioral team consisting of an Executive Director, Operations/Clinical Director, dedicated UM and CM professionals, as well as other corporate supports. The MD will be a Population Health thought and innovation leader working with peers from other MCOs, State Government, and the Community. While the MD will support UM, it will be done in collaboration with a larger group of physician peers from our Western Region. Secondly, the MD is aligned with a group of Psychiatrists offering clinical oversight and direction to Optum's Clinical team. As a team member, the Behavioral Health Medical Director will collaborate cross-functionally with other Optum and UHG partners to design, build and test clinical models to drive better outcomes and affordability for members with complex needs including those with substance use disorders, behavioral and medical health conditions, and unmet social determinants of health, with a vision to improve member engagement in clinically, cost-effective care. The Behavioral Medical Director is responsible for providing clinical oversight to medical-behavioral integrated (MBI) multidisciplinary teams working to engage members in their recovery. This team uses data and performance metrics to design prototypes assessing interventions, stratification and impact, cost, provider performance, and value creation. This individual will interact directly with and offer clinical, procedural, or administrative recommendations to psychiatrists and other behavioral health providers, medical physicians and nurses, clinical professionals, and/or state agencies caring for our community. The Behavioral Medical Director is part of a leadership team managing development and implementation of affordable, evidence-based treatments and regional action planning, and advises leadership on health care system improvement opportunities. Case Management activities include utilization management, case consultation, participation in MBI activities, care engagement-clinical rounds, collaboration with, and participation in the development of case management innovation and evolution. The Behavioral Medical Director participates in quality activities to measure value and promote best practices, including reviewing procedures affecting the quality of care for our members. The Behavioral Medical Director reports directly to the Senior Medical Director for the West region. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Ensuring delivery of cost-effective quality care that incorporates evidence-based practices, recovery, resiliency, and person-centered services + Coordination with multiple medical specialties including behavioral, community-based clinicians, specialists, general practitioners, state agencies, and other stakeholders involved in the implementation of a longitudinal care plan + Works as part of an integrated medical-behavioral team that helps coordinate care engagement, care coordination and MBI activities + Provide clinical supervision to the clinical staff, oversee the management of services at all levels of care in the benefit plan + Keep current regarding Evidence Based Practices and treatment philosophies including those that address MBI, equity, trauma-informed care, recovery, and resilience + Maintaining the clinical integrity of the program, including timely peer reviews, documentation, and consultations + Work collaboratively with the Health Plan Executive Leadership Team + Increase interaction, policy making and advocacy with our state partner + Develop collaborative clinical and value-based partnerships w/ providers 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:** + Doctor of Medicine or Osteopathy + Current license to practice as a physician without restrictions in the state of New Mexico + Currently reside in New Mexico + Board certified in Psychiatry + Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management + Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation, and recovery + Computer and typing proficiency, data analysis and organizational skills + Ability to participate in rotational weekend call coverage **Preferred Qualifications:** + Board certification in Child and Adolescent Psychiatry; Addiction experience/training + 3+ years of experience as a practicing psychiatrist post residency + Managed care experience + Experience in public sector delivery systems and experience in state specific public sector services + Experience working with community-based programs and resources designed to aid the State Medicaid population *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 $258,000 to $423,000 annually based on full-time employment. This role is also eligible to receive bonuses based on sales performance. We comply with all minimum wage laws as applicable. **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._