Medical Director - Outpatient Clinical Review - Remote

Optum is seeking a Medical Director for utilization management review to join our team. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of Optum's vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Work to improve quality and promote evidence-based medicine through outpatient utilization management review
• Work with medical director teams focusing on outpatient and inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review
• Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement
• Support initiatives that enhance quality throughout our national network

• Ensure the right service is provided at the right time for each member

• Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• MD or DO degree
• Active, unrestricted physician license
• Current board certification in ABMS or AOA specialty
• 5+ years of clinical practice experience post residency
• Solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles

Preferred Qualifications:

• Hands-on utilization and/or quality management experience
• Project management or active project participation experience
• Substantial experience in using electronic clinical systems
• Active, unrestricted physician California state license

The scope of this role will include Prior Authorization for Medicare Advantage members focusing on high value procedures such as Myocardial SPECT, PET scans, DME/Home Ventilator, Genetic Testing, and many more. Additionally, the team handles UM functions for the Arizona and New Mexico markets.

What makes and Optum organization different?

• Be part of a best-in-class employee experience that enables you to practice at the top of your license
• We believe that better care for clinicians equates to better care for patients
• We are influencing change collectively on a national scale while still maintaining the culture and community of our local care organizations
• Practice medicine autonomously, with the support, not restrictions, of a sustainable and thriving national health care organization

Compensation & Benefits Highlights

• Guaranteed, competitive compensation model based on quality, not quantity, with significant earning potential, annual increases, and bonus eligibility
• Financial stability and support of a Fortune 5 Company
• Robust retirement offerings including employer funded contributions and Employee Stock Purchase Plan (ESPP for UHG Stock)
• Physician and APC Partnership opportunities and incentives
• Comprehensive benefits plan inclusive of medical, dental, vision, STD/LTD, CME and malpractice coverage
• Robust clinician learning and development programs

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.