Medical Director - Prior Authorization - CA licensure required - Remote

UnitedHealth Group•Torrance, CA

22d•$248,500 - $373,000•Remote

About The Position

This position will support the growing Prior Auth program which covers the California Market. The scope of this role will include Prior Authorization for Medicare Advantage members focusing on high value procedures such as Myocardial SPECT, PET scans, DME/Home Ventilator, Genetic Testing, and many more. Additionally, the team handles UM functions for the California Market. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

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

Nice To Haves

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

Responsibilities

Work to improve quality and promote evidence-based medicine
Prior authorization, utilization management and claims review cases 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
Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review
Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting
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.