SSBV Medical Doctor - Remote

UnitedHealth Group•Plymouth, MN

4d•$248,500 - $373,000•Remote

About The Position

Optum is seeking a Short Stay Billing Validation (SSBV) Medical Director to join their Clinical and Coding Audit (CCAT) team within Optum Insights. This team conducts facility inpatient payment integrity audits for outpatient hospital encounters incorrectly billed as inpatient. The SSBV Medical Directors collaborate with clinical reviews of nurses, focusing on correct billing rather than the severity or necessity of care. This role is part of a national team, requiring collaboration with peers, nurse managers, and non-clinical employees across the country. The position offers the flexibility to work remotely from anywhere within the U.S.

Requirements

MD or DO with an active, unrestricted medical license in the U.S
Board certification up-to-date and in good standing
Current Board Certification in an ABMS or AOBMS specialty
3+ years of clinical practice experience
Technical proficiency in computer software and systems
Proven ability to work collaboratively with nurses, coders, and operational partners in a matrixed environment
Demonstrated excellence with both written and oral communication skills across clinical and non-clinical audiences
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Candidates are required to pass a drug test before beginning employment.

Nice To Haves

2+ years of managed care, Quality Management experience and/or administrative leadership experience
Experience applying evidence-based level-of-care criteria (e.g., InterQual® or MCG) in utilization review or payment integrity settings
Experience with short-stay billing validation, inpatient status review, or physician advisory services in the acute care setting
Experience developing clear, well-supported clinical rationale for billing status determinations and audit findings
Knowledge of CMS guidelines, medical necessity review principles, and payer audit processes

Responsibilities

Provide physician-level review and determination of short-stay inpatient claims to ensure accurate billing status and alignment with evidence-based guidelines
Support audit integrity by delivering clear, defensible clinical rationale and partnering with clinical and operational teams to drive consistent review outcomes
Utilize and apply evidence-based medicine (EBM) such as InterQual®
Collaborate with operational and business partners
Maintain proficiency in all required software and platforms