Optum logo
Optum

Optum, part of the UnitedHealth Group family of businesses, 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. At Optum, we support your well-being with an understanding team, extensive benefits and rewarding opportunities. By joining us, you’ll have the resources to drive system transformation while we help you take care of your future. We recognize the power of connection to drive change, improve efficiency and make a difference in health care. Join a team where your skills and ideas can make an impact and where collaboration is key to creating technology that produces healthier outcomes.

Medical Director, Utilization Management Physician - Optum - Remote

Medical DirectorMedical DirectorFull TimeRemoteSeniorTeam 160,000Since 2011Company Site

Location

Texas

Posted

62 days ago

Salary

$248.5K - $373K / year

Seniority

Senior

Bachelor Degree9 yrs expEnglishMS Office

Job Description

Medical Director, Utilization Management Physician - Optum - Remote

Optum

Requisition Number: 2345838 WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the way clinicians work and live. The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over or under utilization of services and proactively suggesting improvements to WellMed Medical Management's utilization management program. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Position Highlights & Primary Responsibilities: - Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values - Remain current and proficient in CMS criteria hierarchy and organizational determination processes - Participates in case review and medical necessity determination - Maintain proficiency in compliance regulations for both CMS and delegated health plans - Conducts post service reviews issued for medical necessity and benefits determination coding - Assists in development of medical management, care management, and utilization management protocols - Performs all other related duties as assigned Customer Service: - Oversees and ensures physician compliance with UM plan - Performs all duties in a professional and responsible manner - Responds to physicians and staff in a prompt, pleasant and professional manner - Respects physician, patient, and organizational confidentiality - Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met - Personal and Physician Development - Strives to personally expand working knowledge of all aspects of the UM department - An active participant in physician meetings - Orients new physicians to ensure understanding of company policy and resources available for physician support - Assists in the growth and development of subordinates by sharing special knowledge with others and promotes continued education classes - Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone. 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: - Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S. - Board certification in Family Medicine, Internal Medicine, or emergency medicine - An active, unrestricted medical license (any state) - 5+ years of post-residency clinic practice experience - Proficiency with Microsoft Office applications Preferred Qualifications: - 2+ years of experience in utilization management activities - 2+ years of experience with acute admissions - 2+ years of experience working in a managed care health plan environment - Bilingual (English/Spanish) fluency *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $248,500.00 to $373,000.00 annually based on full-time employment. We comply with all minimum wage laws as applicable. 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. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Benefits

  • 401(K), Dental insurance, Disability insurance, Employee stock purchase plan, Family medical leave, Flexible Spending Account (FSA), Generous parental leave, Generous PTO, Health insurance, Job training & conferences, Life insurance, Charitable contribution matching, Paid holidays, Paid sick days, Performance bonus, Tuition reimbursement, Vision insurance, Mental health benefits, Personal development training, Bereavement leave benefits

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