Medical Director

3 weeks ago

San Diego, California, United States Optum Full time
Optum Medical Director Job Description

Optum, a part of the UnitedHealth Group family of businesses, is revolutionizing healthcare by creating an integrated care model that addresses an individual's physical, mental, and social needs. As a Medical Director, you will play a crucial role in shaping the future of healthcare.

Key Responsibilities:
  • Provide daily utilization oversight and communicate effectively with network physicians and hospitals.
  • Conduct daily UM reviews, authorizations, and denial reviews.
  • Engage in peer-to-peer conversations for clinical case reviews, as needed.
  • Conduct provider telephonic reviews and discussions, sharing tools, information, and guidelines related to cost-effective healthcare delivery and quality of care.
  • Communicate effectively with network and non-network providers to ensure the successful administration of Optum's services.
  • Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers.
  • Represent Optum on external levels, identifying, engaging, and establishing/maintaining relationships with other thought leaders.
  • Collaborate with Client Services Teams 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 Optum's leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues.
  • Provide input on local needs for Analytics Teams and Client Services Teams to better enhance Optum's 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.
  • Provide 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 settings.

Optum offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes. 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.

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