UnitedHealth Group

UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of

Part Time UM Medical Director - Plastic Surgeon

Location

United States

Posted

15 days ago

Salary

$248.5K - $373K / year

Seniority

Lead

No structured requirement data.

Job Description

Part Time UM Medical Director - Plastic Surgeon

UnitedHealth Group

Role Description As part of the Focus Claims Review team at Optum, the Medical Director provides leadership, organization, and direction for the claims review program. They are responsible for the overall quality, effectiveness, and coordination of the medical services provided through Optum. The Medical Director will participate in all aspects of claim review services including provider telephonic discussions and provider appeals. In addition, the Medical Director may also be asked to assist in the direction and oversight in the development and implementation of policies and procedures and clinical criteria for all medical programs and services. The Medical Director will serve as a liaison between Optum, physicians, and other medical service providers in selected situations primarily related to medical claim reviews. This role is part-time work from home and will be 20 hours per week. This can be remote work from home anywhere in the United States. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Reviews surgical and other professional claims for correct coding using clinical record. - Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable. - Discusses cases and clinical coding situations with treating providers telephonically during scheduled hours. - Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews. - Composes, if needed, patient situation specific, clinical summaries and rationales for medical necessity decisions. - Is available for occasional, periodic weekend and holiday as needed telephonic and remote computer expedited clinical decisions. - Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers). - Ability to travel to scheduled company meetings and activities in the US. - Ability to assist in marketing presentations to clients and ongoing relationship management activities with existing clients if requested to do so. - Provide Clinical support for staff that conduct initial reviews. - Good understanding of professional performance measurement and related possible discussions/interventions with selected providers/groups/organizations. Qualifications - Current, active, and fully unrestricted medical license. - Current board certification in Plastic Surgery. - 5+ years of clinical experience in Plastic Surgery post residency. - Knowledge or proficiency in MS Office (MS Word, Excel, and Power Point). Requirements - Experience in managed care. - Experience with professional claim coding / claim coding reviews. - Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers. - Knowledge of claim coding resources and techniques. - Proficient computer skills and ability to learn to use clinical and claims software. - Proven excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel. Benefits - Compensation for this specialty generally ranges from $248,500 - $373,000. - Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. - We comply with all minimum wage laws as applicable. - 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. 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.

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