Medical Director
UnitedHealth Group • Indianapolis, IN22d • $248,500 - $373,000 • Remote
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Medical Director, Otolaryngology (ENT) - Remote
UnitedHealth Group•Indianapolis, IN
•$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 help direct and oversee the development and implementation of 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 related primarily to medical claim reviews. This is a remote role that can be performed from anywhere within the United States. The position reviews surgical and other professional claims for correct coding using clinical records, supports staff conducting initial reviews, and helps ensure compliance with regulatory standards and requirements. The role also participates in training, clinical conferences, internal performance consistency reviews, and discussions with treating providers during scheduled hours.
Requirements
- MD or DO with a current, active, and fully unrestricted medical license.
- Current board certification through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) in Otolaryngology (ENT).
- At least 5 years of clinical experience post residency.
- Proficiency with MS Office, including Word, Excel, and PowerPoint.
Nice To Haves
- Experience working for a managed care organization.
- Expertise in facial plastic and reconstructive surgery.
- 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 physicians, nurses, physical therapists, occupational therapists, 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 applicable department-specific topics.
- Discuss cases and clinical coding situations telephonically with treating providers 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 who conduct initial reviews.
- Participate in all aspects of claim review services, including provider telephonic discussions and provider appeals.
- Help direct and oversee development and implementation of policies, procedures, and clinical criteria for medical programs and services, as requested.
- Serve as a liaison between Optum, physicians, and other medical service providers in selected situations primarily related to medical claim reviews.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase.
- 401(k) contribution, subject to eligibility requirements.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
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