Medical Director, Vascular Surgery - Remote

UnitedHealth Group•Tampa, FL

10d•$248,500 - $373,000•Remote

About The Position

As part of Optum’s Focus Claims Review team, the Medical Director provides leadership, organization, and direction for the claims review program and is responsible for the quality, effectiveness, and coordination of medical services. The role participates in claims review services, including telephonic discussions with providers and provider appeals. The Medical Director may also assist with developing and implementing policies, procedures, and clinical criteria for medical programs and services, and serves as a liaison between Optum, physicians, and other medical service providers in selected situations, primarily related to medical claim reviews. This position can be performed remotely from anywhere within the United States. The Medical Director reviews surgical and other professional claims for correct coding, supports staff conducting initial reviews, and helps ensure compliance with applicable regulatory standards and requirements. The salary range is $248,500–$373,000 annually based on full-time employment.

Requirements

MD or DO degree.
Current, active, and fully unrestricted medical license.
Current board certification in Vascular Surgery through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).
At least 5 years of clinical experience after residency.
Proficiency with MS Office, including Word, Excel, and PowerPoint.
Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.
Candidates must pass a drug test before beginning employment.

Nice To Haves

Experience working for a managed care organization.
Experience with professional claim coding or claim coding reviews.
Knowledge of claim coding resources and techniques.
Proficient computer skills and ability to learn clinical and claims software.
Excellent interpersonal skills and ability to work by telephone with colleagues, including physicians, nurses, PTs, OTs, and similar personnel.

Responsibilities

Review surgical and other professional claims for correct coding using clinical records.
Participate in training regarding URAC, NCQA, regulatory compliance, confidentiality, conflict of interest, HIPAA, and department-specific topics as applicable.
Discuss cases and clinical coding situations with treating providers by telephone during scheduled hours.
Participate in periodic clinical conferences or calls and ongoing internal performance consistency reviews.
Compose patient-specific clinical summaries and rationales for medical necessity decisions when needed.
Support compliance with regulatory agency standards and requirements, including CMS, NCQA, URAC, state and federal requirements, and third-party payer requirements.
Provide clinical support for staff conducting initial reviews.
Participate in all aspects of claim review services, including provider telephonic discussions and provider appeals.
Assist, as requested, with direction and oversight in developing and implementing policies, procedures, and clinical criteria for medical programs and services.
Serve as a liaison between Optum, physicians, and other medical service providers in selected situations related primarily to medical claim reviews.