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Medical Director

1 month ago

Dallas, Texas, United States Optum Full time
Optum Medical Director Job Description

At Optum, we're creating a new model of care that addresses the physical, mental, and social needs of individuals. As a Medical Director, you'll play a crucial role in shaping this vision and helping patients navigate care across settings.

Key Responsibilities:
  • Provide daily utilization oversight and external communication 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
  • Communicate effectively with network and non-network providers to ensure successful care transitions
  • Respond to clinical inquiries and serve as a non-promotional medical contact point for healthcare providers
  • Represent Optum on external levels, identifying and establishing relationships with thought leaders
  • Collaborate with Client Services Team to ensure coordinated care delivery
  • Contribute to the development of action plans and programs to address areas of concern and monitor progress toward goals
  • Interact with network and community physicians, hospital leaders, and vendors regarding care and services for enrollees
  • Provide leadership and guidance to maximize cost management through close coordination with network and provider contracting
  • Regularly meet with Optum leadership to review care coordination issues, develop intervention plans, and share ideas about network management
  • Provide input on local needs for Analytics Team and Client Services Team to enhance Optum products and services
  • Ensure appropriate management and resolution of local queries regarding patient case management
  • Participate on the Medical Advisory Board
  • Provide intermittent, scheduled weekend and evening coverage
Requirements:
  • Board certification as an MD, DO, MBBS with a current unrestricted license to practice
  • Current, unrestricted medical license and ability to obtain licensure in multiple states
  • 3+ years of post-residency patient care experience, preferably in inpatient or post-acute settings
Preferred Qualifications:
  • Licensure in multiple states
  • Understanding of population-based medicine and CMS criteria for post-acute care
  • Demonstrated ability to work within a team environment and complete multiple tasks simultaneously
  • Excellent organizational, analytical, verbal, and written communication skills
  • Proven ability to positively interact with clinicians, management, and medical professionals
  • Competence in use of electronic health records and associated technology