Medical Director of Medical Management – Telecommute

UnitedHealth Group
Published
July 9, 2021
Location
Atlanta, GA
Category
Job Type

Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 5 industry leader.

The Medical Director of Medical Management will be responsible for the clinical decision making for newly acquired markets that will be assuming global risk. Will work with operations to complete prior authorization reviews, inpatient concurrent reviews, and post - acute reviews. 

You’ll enjoy the flexibility to telecommute* from anywhere within United States as you take on some tough challenges.

Primary Responsibilities:

  • Make clinical decisions related to the provisions of care
  • Research / analyze clinical or other data / information (e.g., medical records, claims data, authorization data, appeals data)
  • Read / interpret medical / clinical literature and apply understanding of research study design and quality of clinical evidence
  • Review / interpret policies, accreditation standards, regulations, etc. related to medical / clinical topics
  • Consider internal and external reviews (e.g., regulatory audits, litigation, market conduct exam outcomes, third party reviews) in making and documenting determinations
  • Make decisions regarding application of medical policies, programs, organizations, and clinical guidelines
  • Manage, Influence, and Deliver Communication of Clinical Decisions to client, employer, physicians, and healthcare providers
  • Develop and Implement Initiatives requiring clinical expertise
  • Assess and manage clinical operational capability in Medical Management
  • Educate others on clinical, operational topics and programs

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:

  • MD or DO degree
  • Active, unrestricted physician state license
  • Current board certification in ABMS or AOA specialty
  • 2+ years of clinical practice experience post residency
  • 2+ years hands on Utilization Management and Case Management under a risk model
  • 2+ years of CMS familiarity with Medicare and Medicaid requirements as it relates to UM
  • Proven understanding of and concurrence with evidence - based medicine (EBM) and managed care principles
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • Project management or active project participation experience
  • Substantial experience in using electronic clinical systems

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 5, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $254,600 to $295,200. The range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job keywords: Medical Director of Medical Management, ABMS, AOA, Utilization Management, Case Management, CMS, Medicare, Medicaid, UM, EBM, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, Cypress, CA, California

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