Medical Director - Prior Authorization - CA licensure required - Remote

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.

About the role

This position supports the growing Prior Authorization program covering the California Market, focusing on high-value procedures such as Myocardial SPECT, PET scans, DME/Home Ventilator, Genetic Testing, and more. The team also handles Utilization Management (UM) functions for the California Market. You'll enjoy the flexibility to work remotely from anywhere within the U.S.

Responsibilities

• Work to improve quality and promote evidence-based medicine
• Perform prior authorization, utilization management, and claims review for patients
• Provide information on quality and efficiency to doctors, patients, and customers to inform care choices and drive improvement
• Support initiatives that enhance quality throughout our national network
• Ensure the right service is provided at the right time for each member
• Collaborate with medical director teams on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review, and provider appeals clinical review

Requirements

• MD or DO degree
• Active, unrestricted physician state license in CA
• Current board certification through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
• 5+ years of clinical practice experience post-residency
• Proven solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles

Preferred Qualifications

• Hands-on utilization and/or quality management experience
• Prior Authorization experience
• Project management or active project participation experience
• Substantial experience using electronic clinical systems
• Licensure in New Mexico, Utah, Nevada, or Arizona (or willing and able to obtain)

Pay

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, and work experience. Compensation may increase over time based on productivity and performance in the role.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)