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Medical Director

4 weeks ago

Philadelphia, Pennsylvania, United States Optum Full time
Optum Medical Director Opportunity

At Optum, we are committed to transforming healthcare and improving the lives of our patients. We are seeking a highly skilled and experienced Medical Director to join our team.

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 clinical case reviews, as needed
  • Communicate effectively with network and non-network providers to ensure 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 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 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 Team and Client Services Team 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 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