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Utilization Management Medical Director - Telecommute in TN

Company: Optum
Location: Franklin
Posted on: September 21, 2022

Job Description:

Medical Director opening in Franklin, Tennessee. This and other physician jobs brought to you by DocCafe

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)

Medical Director careers at UnitedHealth Group are anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Instead of seeing one patient at a time, you have the opportunity to impact health care trend across the population with data driven information and tools to drive evidence-based care. Join us. And start doing your life's best work.(sm)

We are currently seeking a Utilization Management Medical Director for a remote / telecommuter position. The Medical Director to provide utilization management review and oversight as part of our service delivery for our Tennessee clients. This work involves a Medicare Advantage payor. The Medical Director will use health plan and industry wide guidelines with adjudications. Excellent interpersonal communications skills are needed in this role.

If you are located in TN, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

Responsible for daily UM reviews (authorizations and adverse determination reviews) and coverage reviews based on individual member plan benefits, national, state, CMS and proprietary coverage review policies and render determinations
Conduct peer to peer conversations for the clinical case reviews and coverage reviews, as needed to review and discuss and share tools, information, and evidence-based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expenses as they relate to cost-effective healthcare delivery and quality of care
Participate in telephonic outreach for collaboration with treating providers
Is grounded in the use and application of evidence-based medicine (EBM), InterQual, etc.
Provide daily utilization oversight and external communication with network physicians and hospitals
Maintain proficiency in all required software and platforms
Effectively engage and articulate the Optum and UHC value story to our external constituents such as physicians and our customers
Adhere to medical director performance metrics and evaluations
Knowledge of admission, readmission data, and overall medical expense that would drive changes in focus at the case level
Support quality reviews, inter-rater reliability sessions, regulatory requirements, and accreditation and certification efforts. Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
Perform other duties and responsibilities as required, assigned, or requested

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 with an active, unrestricted medical license in the state of Tennessee; must reside in the state of TN
  • Current Board Certification in an ABMS or AOBMS specialty
  • 3+ years of clinical practice experience post residency
  • Excellent written and oral communication skills with customer facing experience
  • Excellent project management skills
  • Proficiency with Microsoft Office applications
  • Solid data analysis and interpretation skills; Ability to focus on key metrics
  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

    Preferred Qualifications:

    • Proficiency with InterQual and MCG criteria
    • Medicare Advantage experience
    • 2+ years of managed care experience with UM level of care and length of stay determinations and preservice prior authorizations

      To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

      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.

      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.

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Keywords: Optum, Franklin , Utilization Management Medical Director - Telecommute in TN, Healthcare , Franklin, Tennessee

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