Medical Director - Licensed and Residency in Florida - Remote

UnitedHealth Group•Orlando, FL

8d•$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. Here at Optum, we have an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs. The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on post-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member's primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost effective quality medical care is provided to members. If you reside in Florida, you will have the flexibility to work remotely as you take on some tough challenges.

Requirements

Doctor of Medicine or Osteopathy
Current active, unrestricted license to practice as a physician without restrictions in the state of FL
Current board certification in Internal Medicine or Family Practice
5+ years of clinical practice experience after completing residency training
Substantial experience in using electronic clinical systems
Solid belief in EBM (Evidence Based Medicine), and familiarity with current medical issues and practices
PC skills, specifically using MS Word, Outlook, and Excel
Ability to participate in rotational weekend and holiday call coverage
Currently reside in Florida

Nice To Haves

Hands-on experience in utilization review
Clinical practice experience in the last 2 years
Data analysis experience
Data analysis and interpretation experience and skills
Sound knowledge of the managed care industry
Proven excellent presentation skills for both clinical and non-clinical audiences

Responsibilities

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements
Engage with requesting providers as needed in peer-to-peer discussions
Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
Participate in daily clinical rounds as requested
Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
Communicate and collaborate with other internal partners