Part Time UM Medical Director - Plastic Surgeon - Remote anywhere in US
About The Position
As part of the Focus Claims Review team at Optum, the Medical Director provides leadership, organization, and direction for the claims review program. They are responsible for the overall quality, effectiveness and coordination of the medical services provided through Optum. The Medical Director will participate in all aspects of claim review services including provider telephonic discussions and provider appeals. In addition, the Medical Director may also be asked to assist in the direction and oversight in the development and implementation of policies and procedures and clinical criteria for all medical programs and services. The Medical Director will serve as a liaison between Optum, physicians, and other medical service providers in selected situations primarily related to medical claim reviews. This role is part time work from home and will be 20 hours per week. This can be remote work from home anywhere in the United States. 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 in Plastic Surgery
- 5+ years of clinical experience in Plastic Surgery post residency
- Knowledge or proficiency in MS Office (MS Word, Excel, and Power Point)
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Nice To Haves
- Experience in managed care
- Experience with professional claim coding / claim coding reviews
- 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
- Knowledge of claim coding resources and techniques
- Proficient computer skills and ability to learn to use clinical and claims software
- Proven excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel
Responsibilities
- Reviews surgical and other professional claims for correct coding using clinical record
- Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
- Discusses cases and clinical coding situations with treating providers telephonically during scheduled hours
- Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews
- Composes, if needed, patient situation specific, clinical summaries and rationales for medical necessity decisions
- Is available for occasional, periodic weekend and holiday as needed telephonic and remote computer expedited clinical decisions
- Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers)
- Ability to travel to scheduled company meetings and activities in US
- Ability to assist in marketing presentations to clients and ongoing relationship management activities with existing clients if requested to do so
- 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
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
