Orthopedic or Spine Medical Director - Remote

UnitedHealth Group•Eden Prairie, MN

9d•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. As part of the Focus Claims Review team at Optum, the Medical Director provides leadership, organization, and direction for the claims review program. 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 coding and procedures. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. 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.

Requirements

Current, active, and fully unrestricted medical license
Current board certification in Orthopedic Surgery
5+ years of clinical experience in Orthopedic surgery; specialized in spinal surgery post residency
Proficient 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
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 & spinal 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
Discuss cases and clinical coding situations with treating providers telephonically during scheduled hours
Participates in periodic coding conferences / calls and in ongoing internal performance consistency reviews
Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers)
Provide Clinical support for staff that conduct initial reviews