Title: UM Medical Director - Orthopedic Spine, Neurosurgery or Spine Surgery Locations : Minneapolis, MN Baltimore, Maryland | Houston, Texas | Miami, Florida | Phoenix, Arizona | New York, New York | Chicago, Illinois Work Type: Remote, Full Time Job ID: 2361607 Job Description: Optum 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. Position in this function is responsible, in part, as a member of a team of medical directors, for the overall quality, effectiveness and coordination of the medical review services. Additionally, performs Utilization Management reviews and directs/coordinates aspects of the utilization review staff activities, and participates in the Quality Improvement programs for the company. The Medical Director also provides/assists in the direction and oversight in the development and implementation of policies, procedures and clinical criteria for all medical programs and services and may serve as a liaison between physicians, and other medical service providers in selected situations. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations. The focus of the coverage reviews will be various types of musculoskeletal and other medical/surgical services which will include prior authorizations for spine surgery - Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements. Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers) - Works with clinical staff to coordinate all the necessary coverage reviews and provides feedback to staff who do portions of the coverage reviews - Engage with requesting providers as needed in peer-to-peer discussions - Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews - Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews - Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy - Communicate and collaborate with other internal partners - Call coverage rotation. Is available for periodic weekend and holiday coverage as needed for telephonic and remote computer expedited clinical decisions - Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable - Good understanding of professional performance measurement and related possible discussions/interventions with selected providers/groups/organizations 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: - Current, active and unrestricted medical license - Current Board Certification in Orthopedic Surgery or Neurosurgery through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) - 5+ years clinical experience post residency in Orthopedic Surgery or Neurosurgery to include experience with musculoskeletal/ spine surgery - Sound understanding of Evidence Based Medicine (EBM) - Proficient with MS Office (MS Word, Email, Excel, and Power Point) - Excellent computer skills and ability to learn new systems and software - Excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel - Willing to obtain additional licenses as needed Preferred Qualifications: - Active license in South Carolina, Minnesota or Texas, but candidates with an active license in other states are acceptable - ABMS or other nationally recognized further specialized certifications - Experience in managed care UM activities/ coverage 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 - Possess leadership skills in working with other physicians, knowledge of the overall medical community and the local / regional managed care environments No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. 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.

Requisition number: 2364250 Job category: Medical & Clinical Operations Primary location: Atlanta, GA Additional locations: Phoenix, Arizona | Miami, Florida | Tampa, Florida | Indianapolis, Indiana | Cincinnati, Ohio | Boston, Massachusetts | Las Vegas, Nevada | New York, New York | Baltimore, Maryland Overtime status: Exempt Travel: No Job Description: Optum 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs. The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member's primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost-effective quality medical care is provided to members. You'll enjoy the flexibility to work remotely as you take on some tough challenges. Please note, the hours of this position will be based on PST time zone. Primary Responsibilities: - Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations - Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements - Engage with requesting providers as needed in peer-to-peer discussions - Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews - Participate in daily clinical rounds as requested - Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy - Communicate and collaborate with other internal partners - Call coverage rotation 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: - M.D or D.O. - Board certification in Otolaryngology (ENT) - Active unrestricted license to practice medicine - 5+ years of clinical practice experience after completing residency training - Demonstrated sound understanding of Evidence Based Medicine (EBM) - Proven solid PC skills, specifically using MS Word, Outlook, and Excel - Proven ability to participate in call coverage rotation Preferred Qualifications: - Experience in utilization and clinical coverage review - Proven excellent oral, written, and interpersonal communication skills, facilitation skills - Proven data analysis and interpretation aptitude - Proven innovative problem-solving skills - Proven excellent skills for both clinical and non-clinical audiences *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. 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. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group 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.

Utilization Management Medical Director - Plastic Surgeon Location: Remote, United States Job Description: Requisition number: 2364201 Job category: Medical & Clinical Operations Primary location: Philadelphia, PA Additional locations: Phoenix, Arizona | San Diego, California | Denver, Colorado | Atlanta, Georgia | Houston, Texas | Boston, Massachusetts | Minneapolis, Minnesota | Cleveland, Ohio | Chicago, Illinois Overtime status: Exempt Travel: No Optum 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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 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 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 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: - 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) Preferred Qualifications: - 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 *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. 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. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: 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.

Role Description The U.S. Director, Payor & Access Strategy Lead, Medical Affairs (PASL), position resides in the Value & Implementation (V&I) organization, which includes Global Medical and Scientific Affairs as well as Outcomes Research. The US PASL is responsible for U.S. Field Medical (FM) strategy, training and prioritization of the V&I plan for U.S. Medical Affairs (USMA) Health Systems Oncology (HSO). The PASL for health systems oncology is an impactful member of USMA cross-functional teams, U.S. Medical Affairs Teams (USMATs), and Value Teams (VTs). This US PASL role will be responsible for oncology biomarkers & precision medicine, pan tumor topics, and the HSO pipeline. As organizational needs evolve, the US PASL may assume selected asset-related responsibilities. The US PASL drives U.S. HSO strategic excellence and optimizes HSO and USMA readiness in support of payor access and pharmacoeconomic and scientific exchange aligned to global V&I plan priorities. This is a regionally based position (U.S.) in our company’s Research and Development (R&D) division. Responsibilities and Primary Activities - Is responsible for the direction, coordination, implementation, control, and execution of USMA and HSO payor and access strategy while remaining aligned to global medical and commercial strategy, commitments and goals. - Leads the U.S. HSO integrated Field Medical (FM) plan process in collaboration with U.S. HSO Executive Director (US HSO ED), U.S. HSO Sr Director PASL, U.S. HSO Team Leads, and other members of the global and regional cross-functional teams. - Develops and directs payor and access strategy in alignment with organizational priorities and unmet needs, including precision medicine-related biomarkers, companion diagnostics, and LDT-based diagnostic approaches. - Collects, analyzes and communicates scientific insights from U.S. HSO Medical Affairs Director (MAD) field engagements to inform company strategies across R&D, which includes the V&I and Commercial organizations. - Leads U.S. Payor Access Team (US PAT) to support prioritizing U.S. gaps/needs assessment as well as value-evidence strategy and tactical plan for global V&I annual planning input (e.g., one-pagers, V&I plans, and Country Medical Affairs Plan). - Serves as U.S. Health Systems Oncology interface between V&I, Commercial, and other relevant headquarters (HQ) functions and the U.S. HSO Team. - Identifies and prioritizes U.S. HSO field resources, training needs, and activities across the oncology portfolio to optimize HSO MAD Field Team readiness. - Collaborates with key stakeholders to define/implement strategic congress priorities for U.S. HSO and coordinates planning of HSO MAD activities at key scientific congresses. - Continuously scans the health-care environment and quality landscape to analyze emerging trends in the oncology, precision medicine, and competitive landscape, in addition to market access to optimize U.S. HSO Field Team capabilities. - Represents USMA HSO, in partnership with global V&I, in Expert Input Forums or Advisory Boards, as needed. Qualifications - Advanced health-care/science degree (MD, PhD, or PharmD) and recognized medical expertise in oncology precision medicine/biomarkers. - Five or more years of prior pharmaceutical industry experience (preferably Field Medical experience or equivalent biotech/pharmaceutical/Medical Affairs strategy experience) within oncology and precision medicine; OR five or more years of experience working in quality/managed-care/cancer-center settings, with demonstrated oncology and precision medicine scientific acumen; OR Board-Certified Oncology Pharmacist (BCOP)/Board-Certified Pharmacotherapy Specialist (BCPS) with five or more years of clinical experience working within a cancer center; OR equivalent. - Demonstrated ability to create and implement a strategic plan. - Excellent interpersonal, communication, networking, and results-oriented project-management skills. - Strong understanding of the oncology diagnostics, biomarker, and reimbursement landscape. - Thorough knowledge of clinical medicine, U.S. health-care delivery-system structure and function, pharmacoeconomics, population health management, quality management, value-based payment, and health-care delivery policy and trends. - Demonstrated ability to effectively work in a complex, matrixed environment (promoting inclusion, maintaining trust, and respecting others). - Ability to network and partner with important internal and external stakeholders, including cross-functional teams, scientific leaders, and key decision-makers. - Knowledge of national and society treatment guidelines related to oncology and precision medicine, clinical research processes, U.S. Food & Drug Administration (FDA) regulations, and Office of the Inspector General (OIG), Health Insurance Portability and Accountability Act (HIPAA), and other ethical guidelines, laws and regulations relevant to the pharmaceutical industry and its external stakeholder environment. - Embrace an AI-first mindset by leveraging artificial intelligence (AI) tools and demonstrating a willingness to learn and implement new approaches, without requiring deep technical expertise. Requirements - Experience engaging US access stakeholders relevant to diagnostics and biomarker-driven care. - Strategy experience for a specialty product approval where precision medicine played a role. - Prior experience leading complex projects with demonstrated ability to handle multiple projects and priorities simultaneously and function in a fast-paced environment. - Formal training in pharmacoeconomics/outcomes research. Benefits - Comprehensive package of benefits including medical, dental, vision healthcare and other insurance benefits (for employee and family). - Retirement benefits, including 401(k). - Paid holidays, vacation, and compassionate and sick days. - Annual bonus and long-term incentive eligibility, if applicable.