Medical Director, Utilization Management Physician - Optum - Remote

Position Highlights & Primary Responsibilities

• Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values
• Remain current and proficient in CMS criteria hierarchy and organizational determination processes
• Participates in case review and medical necessity determination
• Maintain proficiency in compliance regulations for both CMS and delegated health plans
• Conducts post service reviews issued for medical necessity and benefits determination coding
• Affords assistance in developing medical management, care management, and utilization management protocols
• Performs all other related duties as assigned

Customer Service

• Oversees and ensures physician compliance with UM plan
• Performs all duties in a professional and responsible manner
• Responds to physicians and staff in a prompt, pleasant and professional manner
• Respects physician, patient, and organizational confidentiality
• Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met

Personal and Physician Development

• Strives to personally expand working knowledge of all aspects of the UM department
• An active participant in physician meetings
• Orients new physicians to ensure understanding of company policy and resources available for physician support
• Affords assistance in the growth and development of subordinates by sharing special knowledge with others and promoting continued education classes
• Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines

Required Qualifications

• Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S.
• Board certification in Family Medicine, Internal Medicine, or emergency medicine
• An active, unrestricted medical license (any state)
• 5+ years of post-residency clinic practice experience
• Proficiency with Microsoft Office applications

Preferred Qualifications

• 2+ years of experience in utilization management activities
• 2+ years of experience with acute admissions
• 2+ years of experience working in a managed care health plan environment
• Bilingual (English/Spanish) fluency

Pay and Benefits

The salary for this role will range from $248,500.00 to $373,000.00 annually based on full-time employment. We comply with all minimum wage laws as applicable.

We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

Job posting may come down early due to volume of applicants.