Medical Director - Pain Management Specialist - Remote

UnitedHealth Group•Minneapolis, MN

10d•$238,000 - $357,500•Remote

About The Position

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. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together . Responsible, in part, as a member of a team of medical directors, for the overall quality, effectiveness and coordination of the medical review services. Additionally, performs Utilization Management reviews and directs/coordinates aspects of the utilization review staff activities, and participates in the Quality Improvement programs for the company. The Medical Director also provides/assists in the direction and oversight in the development and implementation of policies, procedures and clinical criteria for all medical programs and services and may serve as a liaison between physicians, and other medical service providers in selected situations. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

Current, active, and fully unrestricted medical license
Current Board Certification and must maintain pain subspecialty with specialty in either PM&R or Anesthesia
5+ years clinical experience post residency in Pain subspecialty
Proficient with MS Office (MS Word, Email, Excel, and Power Point)
Excellent computer skills and ability to learn new systems and software
Excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel
Participate in rotational call coverage
Must be willing and able to obtain additional medical licenses as needed

Nice To Haves

License in North Carolina or New Mexico a plus
Experience in managed care UM activities
Must possess leadership skills in working with other physicians, knowledge of the overall medical community and the local / regional managed care environments
Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers

Responsibilities

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations. The focus of the coverage reviews will be various types of musculoskeletal and other medical/surgical services which will include prior authorizations for Pain Management procedures ( e.g. spinal chord stimulators, pain pumps, nerve ablations, facet injections, etc.)
Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements.
Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers)
Works with clinical staff to coordinate all the necessary UM processes and provides feedback to staff who do portions of the UM reviews
Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
Discusses cases and clinical situations with treating providers telephonically during scheduled hours
Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews
Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
Participate in rotational call coverage. Is available for occasional, periodic weekend and holiday as needed telephonic and remote computer expedited clinical decisions
Provide Clinical support for staff that conduct initial reviews
Good understanding of professional performance measurement and related possible discussions/interventions with selected providers/groups/organizations