Medical Director
4 weeks ago
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.
Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs.
The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services.
The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member’s primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost-effective quality medical care is provided to members.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
- Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements
- Engage with requesting providers as needed in peer-to-peer discussions
- Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
- Participate in daily clinical rounds as requested
- Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
- Communicate and collaborate with other internal partners
- 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 Hematology - Oncology, General Surgery, Rheumatology, Internal Medicine, or PM&R preferred.
- 5+ years of clinical practice experience after completing residency training
- Sound understanding of Evidence Based Medicine (EBM)
- 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.
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 per year. 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.
-
Corporate Accounts Director
1 week ago
Seattle, United States PENTAX Medical Full timePosition: Corporate Accounts Director - Medical DeviceLocation:Seattle, WAJob Id: 08282024B# of Openings: 1About PENTAX Medical Our mission is to improve the standard of patient care and quality of healthcare delivery by providing the best endoscopic products and services with a focus on QUALITY, CLINICALLY RELEVANT INNOVATION, and SIMPLICITY. Through...
-
West Coast Corporate Accounts Director
1 week ago
Seattle, United States PENTAX Medical Full timeAbout PENTAX Medical Our mission is to improve the standard of patient care and quality of healthcare delivery by providing the best endoscopic products and services with a focus on QUALITY, CLINICALLY RELEVANT INNOVATION, and SIMPLICITY. Through leading edge R&D and manufacturing, PENTAX Medical provides endoscopic imaging devices and solutions to the...
-
Senior Medical Director
2 weeks ago
Seattle, United States Downtown Emergency Service Center Full timeDescription: Supervised by: Executive Director Days Off: Saturday, Sunday Shift: Office Day Insurance Benefits: Medical, Dental, Life, Long-term Disability Other Benefits: Employee Assistance Program (EAP), Flexible Spending Account (FSA), ORCA card subsidy, Paid Time Off (34 days per year), Retirement Plan Please include in your application a cover letter...
-
Medical Director, Geriatrics
14 hours ago
Seattle, United States One Medical Full timeAbout Us One Medical is a primary care solution challenging the industry status quo by making quality care more affordable, accessible and enjoyable. But this isn't your average doctor's office. We're on a mission to transform healthcare, which means improving the experience for everyone involved - from patients and providers to employers and health...
-
Medical Director, Geriatrics
2 days ago
Seattle, United States One Medical Full timeAbout UsOne Medical is a primary care solution challenging the industry status quo by making quality care more affordable, accessible and enjoyable. But this isn’t your average doctor’s office. We’re on a mission to transform healthcare, which means improving the experience for everyone involved - from patients and providers to employers and health...
-
Senior Medical Director
3 months ago
Seattle, United States Downtown Emergency Service Center Full timeJob DescriptionJob DescriptionDescription:Supervised by: Executive DirectorDays Off: Saturday, SundayShift: Office DayInsurance Benefits: Medical, Dental, Life, Long-term DisabilityOther Benefits: Employee Assistance Program (EAP), Flexible Spending Account (FSA), ORCA card subsidy, Paid Time Off (34 days per year), Retirement PlanPlease include in your...
-
Psychiatrist/Medical Director
3 months ago
Seattle, United States Fcs Co Full timeTop notch 70-bed inpatient facility right in Seattle is looking for a Medical Director. This facility cares for severely and persistently mentally ill patients who are involuntarily committed. This is a great opportunity for a psychiatrist who is looking to step up into a leadership role. Great pay and benefits and most importantly and fantastic, dynamic...
-
Senior Medical Director
4 days ago
Seattle, Washington, United States DESC Full timeAbout the PositionDESC is a nonprofit organization dedicated to providing comprehensive healthcare services to individuals with complex needs. As a Senior Medical Director, you will play a key role in leading our medical services team and collaborating with partner organizations to bring healthcare to our clients.Key ResponsibilitiesLead the planning,...
-
Seattle, United States Drs Now Full time $120 - $300Job DescriptionJob DescriptionWe are currently seeking a Telemedicine Physician- Medical Director Opportunities Available to join our team! You will focus on providing high quality patient care as part of a healthcare team.Responsibilities:Prescribe medications and treatmentsAssess patient health through interviews and physical examinationsCommunicate...
-
Medical Director Washington State
1 day ago
Seattle, Washington, United States Direct Staffing Inc Full timeMedical Director Washington StateJob SummaryDirect Staffing Inc is seeking a highly experienced Medical Director to lead our healthcare operations in Washington State. As a key member of our team, you will be responsible for the administration of medical services, developing and implementing clinical policies, and managing medical management staff.Key...
-
Medical Director
5 days ago
Seattle, Washington, United States Tbwa ChiatDay Inc Full timeJob SummaryWe are seeking a seasoned Medical Director to provide strategic clinical expertise and guidance to our Partner Success & Research team. As a key member of our organization, you will play a critical role in ensuring the accuracy and relevance of our data and analyses through clinical validation and expert consulting.Key ResponsibilitiesCollaborate...
-
Medical Director
2 months ago
Seattle, United States UnitedHealth Group Full timeOptum 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,...
-
Senior Medical Director
2 weeks ago
Seattle, WA, United States Downtown Emergency Service Center Full timeDescription: Supervised by: Executive Director Days Off: Saturday, Sunday Shift: Office Day Insurance Benefits: Medical, Dental, Life, Long-term Disability Other Benefits: Employee Assistance Program (EAP), Flexible Spending Account (FSA), ORCA card subsidy, Paid Time Off (34 days per year), Retirement Plan Please include in your application a cover letter...
-
Area Director, Medical Science Liaisons
2 months ago
Seattle, United States Merz Therapeutics Full time** This role is remote in the Western 2/3rds of the US and requires being near a major airport ** This is a 60% travel role leading Medical Science Liaisons including MI, N. IN, IL, MO, OK, TX and all states westward Who We Are: Harvesting Hope with a Growing Family At Merz Therapeutics, we take a nurturing approach to our organization – treating...
-
Director of Medical Science Liaisons
15 hours ago
Seattle, Washington, United States Merz Therapeutics Full timeJob SummaryMerz Therapeutics is seeking a highly skilled and experienced professional to fill the role of Area Director, Medical Science Liaisons. This position will be responsible for managing the activities of the Medical Science Liaison (MSL) team to develop and implement strategies that optimize thought leader/academic institution relationships, increase...
-
Psychiatrist/Medical Director
2 months ago
Seattle, WA, United States FCS, Inc. Full timeTop notch 70-bed inpatient facility right in Seattle is looking for a Medical Director. This facility cares for severely and persistently mentally ill patients who are involuntarily committed. This is a great opportunity for a psychiatrist who is looking to step up into a leadership role. Great pay and benefits and most importantly and fantastic, dynamic...
-
Medical Director
20 hours ago
Seattle, Washington, United States Catholic Health Initiatives Full timeAbout UsCatholic Health Initiatives, a leading healthcare provider, is committed to delivering exceptional patient care and experiences. Our organization is dedicated to making a positive impact on the health and well-being of our communities.Our MissionWe strive to be the preferred choice for healthcare in the Puget Sound region, providing compassionate and...
-
Medical Director
5 days ago
Seattle, Washington, United States Tbwa ChiatDay Inc Full timeJob SummaryWe are seeking a seasoned Medical Director to provide strategic clinical expertise and guidance to our Partner Success & Research team. As a key member of our organization, you will play a critical role in ensuring the accuracy and relevance of our data and analyses through clinical validation and expert consulting.Key ResponsibilitiesStrategic...
-
Lead Medical Officer
1 week ago
Seattle, Washington, United States Downtown Emergency Service Center Full timeSupervised by: Executive Director Days Off: Saturday, Sunday Shift: Office Day Insurance Benefits: Medical, Dental, Life, Long-term Disability Other Benefits: Employee Assistance Program (EAP), Flexible Spending Account (FSA), ORCA card subsidy, Paid Time Off (34 days per year), Retirement Plan About DESC:DESC (Downtown Emergency Service Center) is a...
-
Lead Medical Officer
1 week ago
Seattle, Washington, United States Downtown Emergency Service Center Full timeSupervised by: Executive Director Days Off: Saturday, Sunday Shift: Office Day Insurance Benefits: Medical, Dental, Life, Long-term Disability Other Benefits: Employee Assistance Program (EAP), Flexible Spending Account (FSA), ORCA card subsidy, Paid Time Off (34 days per year), Retirement Plan About DESC:DESC (Downtown Emergency Service Center) is a...
