Medical Director Clinical Advocacy and Support (Medicare) - Telecommute
Company: UnitedHealth Group
Posted on: January 9, 2022
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
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 telecommute* from anywhere within
the U.S. as you take on some tough challenges.
Conduct coverage reviews based on individual member plan benefits
and national and proprietary coverage review policies, render
Document clinical review findings, actions and outcomes in
accordance with policies, and regulatory and accreditation
Engage with requesting providers as needed in peer-to-peer
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
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.
M.D or D.O.
Active unrestricted license to practice medicine
Board certification approved by the American Board of Medical
5+ years of clinical practice experience after completing residency
Sound understanding of Evidence Based Medicine (EBM)
Solid PC skills, specifically using MS Word, Outlook, and Excel
Board Certification in Internal Medicine, Cardiology, Pulmonology,
Current licensure in Texas or Tennessee
Experience in utilization and clinical coverage review
Excellent oral, written, and interpersonal communication skills,
Data analysis and interpretation aptitude
Innovative problem-solving skills
Excellent presentation skills for both clinical and non-clinical
UnitedHealth Group requires all new hires and employees to report
their COVID-19 vaccination status.
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)
*All Telecommuters will be required to adhere to UnitedHealth
Group's Telecommuter Policy.
Colorado Residents Only: The salary range for Colorado residents is
$254,600 to $ 295,200. 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.
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 Clinical Advocacy Support, Texas,
TX, Tennessee, TN, Telecommute, Telecommuter, Telecommuting, Work
at Home, Work from Home, Remote
Keywords: UnitedHealth Group, Franklin , Medical Director Clinical Advocacy and Support (Medicare) - Telecommute, Executive , Franklin, Tennessee
Didn't find what you're looking for? Search again!