13 days old

Life and Disability Medical Director – Portland, Maine

South Portland, ME 04106
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  • Job Code
    866825
Life and Disability Medical Director - Portland, Maine

What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.

Medical Directors work in partnership with attending physicians and other care providers to determine appropriate level of care and to ensure quality outcomes.

The Medical Director provides expert medical analysis of complex disability claims files; participate in developing and conducting training curricula to nurses and non-clinical team members; interact with the claimant's attending healthcare provider; and participate in special projects.

Positions in this function are MD's that performs medical claim analysis that effectively addresses both objective and subjective disability issues. The function includes roles which manage development and implementation of medical expense management initiatives, advises industry leading leadership on improvement opportunities regarding medical expense programs and clinical activities that impact disability expenses.

Job responsibilities:
-Research/analyze clinical or other data/information (e.g., medical records, claims data, authorization data, appeals data)
-Read/interpret medical/clinical literature and apply understanding of research study design and quality of clinical evidence
-Review/interpret policies, accreditation standards, regulations, etc. related to medical/clinical topics
-Conduct assessments of medical policies/policy implementation and clinical operations within the organization and department
-Gather/review clinical and other information related to specific cases or decisions (e.g., contact and listen to providers; case managers)
-Consider/evaluate concerns/perspectives/requirements related to medical/clinical decisions, policies, and processes (e.g., members, network providers, regulators, accreditors, legal/risk management, and employers)
-Identify and consider delegate performance as well as company actions, inactions, errors, or omissions that may impact clinical decisions
-Consider internal and external reviews (e.g., regulatory audits, litigation, market conduct exam outcomes, third party reviews) in making and documenting determinations
-Make decisions regarding application of medical policies, programs, organizations, and clinical guidelines
-Make clinical case review decisions/judgments in relevant areas (e.g., quality of care, case management aspects to address, coverage decisions, prior authorization)
-Develop clinical understanding outside the specialty or sub-specialty of post-graduate training to broaden clinical expertise and make relevant interpretations
-Read and interpret contracts and apply contract provisions to the clinical review process
-Present clinical programs/results to others (e.g., client/employer meetings, physicians, healthcare providers)
-Deliver group presentations on clinical programs/data/information
-Explain/influence development of technical/clinical communications that will be delivered to external audiences (e.g., new clinical policies, programs, processes)
-Discuss clinical program outcomes/data/performance with providers/employers/accreditors/regulators
-Deliver clinical/coverage decisions/information and respond to questions/concerns (e.g., from regulators, accreditors, legal/risk management, employers, healthcare providers)
-Manage challenging conversations with appropriate interpersonal dynamics when discussing medical decisions and areas of disagreement
-Discuss case information with internal or external parties (e.g., case managers, other medical directors, clinical providers, physicians)
-Provide feedback to team members and other departments to refine decision making and promote a shared understanding of benefit or coverage decisions
-Document case summaries and clinical determinations that are clear/understandable for appropriate audiences
-Develop/update/review relevant clinical and other documents (e.g., clinical guidelines, operational policies, benefit documents, SOPs)
-Develop/recommend/implement quality/affordability/service initiatives
-Solicit or respond to feedback/input on clinical initiatives/guidelines (e.g., providers, specialty societies, clinical experts)
-Evaluate clinical and other data/reports (e.g., quality metrics, claims data, usage data) to identify opportunities for improvement of clinical reviews and processes
-Assess and interpret complex financial and clinical data to evaluate feasibility of proposed initiatives
-Assess current and prospective staff's clinical knowledge/capability and the ability to apply these skills in supporting a claim management environment
-Identify and address gaps in clinical/medical/administrative knowledge/skills of internal team members
-Conduct self-assessment of competence in various areas of medicine and implement development strategies to build knowledge and apply evidence based --medicine to perform in these clinical areas
-Identify process improvement opportunities to enhance clinical operations
-Identify/implement development resources in response to business needs/ regulatory changes
-Identify and address variability in clinical decision making across staff
-Educate/train/orient/mentor staff with medical backgrounds to build their capabilities in supporting a claim management
-Deliver presentations to others (e.g., employer groups, internal staff) on clinically-related topics
-Educate others
-Educate teams on clinical quality/service initiatives
-Communicate new/updated medical policies
-Explain changes/details of clinical policies/clinical programs to individuals or groups

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Posted: 2020-03-20 Expires: 2020-04-20

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Life and Disability Medical Director – Portland, Maine

UnitedHealth Group
South Portland, ME 04106

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