Medical Director

3 days ago


Dallas, Texas, United States UnitedHealth Group Full time
Medical Director Opportunity at UnitedHealth Group

UnitedHealth Group is seeking a highly skilled Medical Director to join our team at Optum Home & Community Care. As a Medical Director, you will play a critical role in leading our efforts to transform healthcare delivery and improve patient outcomes.

Key Responsibilities:
  • Provide daily utilization oversight and external communication with network physicians and hospitals
  • Conduct daily UM reviews - authorizations and denial reviews
  • Conduct peer to peer conversations for the clinical case reviews, as needed
  • 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
Requirements:
  • 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

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