Family Practice Full-Time position in Irvine, California
7 days ago
Caring. Connecting. Growing together.
Life Changing Work
Want to make a real difference in the lives you touch?
LOOK NO FURTHER.
Optum is a physician-led, close-knit team that has been long-respected in Southern California. We are passionate about patients. We are leading the state of California toward better healthcare practices. And we are looking for amazing doctors like you.
Position Highlights:
- Schedule: Monday - Friday, remote and office based
- Call: 1:4 (approximately 2-3 hours over weekend)
- Timely review of requests for service; performing pre-service authorization review and post- service / claims review and make determination based on medical necessity and appropriateness of care within established guidelines
- Clearly and accurately document all communication and decision-making and meet appropriate turn-around times for clinical reviews
- Conduct timely peer-to-peer discussion with providers to clarify clinical information and explain review outcomes, including feedback on alternate treatment based on medical necessity criteria
- Adhere to regulatory, health plan, and clinical guidelines for denials
- Work collaboratively with UM Review Physicians and Care Management team
- Attend monthly Utilization Management meeting for region
- Participate in weekly interdisciplinary team calls
- Participate in health plan joint operations meetings and audits as necessary
- Position will cover designated regions and may require occasional travel to sites or regional office
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:
- Unrestricted CA Medical License
- Current CA DEA certificate prior to start date
- Current Board Certification Family/Internal Medicine, Pediatrics
- 3+ years clinical experience
- 2+ years of experience in medical group, health plan setting; prior authorization review experience
- Knowledge of health plan and regulatory requirements
- Excellent working knowledge of CMS regulations
- Proficient with CPT and ICD-10 codes
- Computer proficient
- Proven excellent oral and written communication skills
- Proven ability to work independently
California Residents Only: The salary range for this role is $273,584 to $380,852 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.
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