20 days old

Market Medical Director - West Valley, UT

West Valley City, UT 84119
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OptumCare is seeking a Market Medical Director to join our Clinical Analysis and Consulting Team in West Valley, UT. You will have the opportunity to drive measureable and meaningful outcomes in the Salt Lake City Market with other members of the team. You will be responsible for improving the quality and efficiency of medical care in the market, and leading the provider network.

Primary Responsibilities:
  • This role will require you to be out in the field with daily travel within the Salt Lake City market, developing and maintain collegial relationships with contracted Providers in efforts to support the business efforts of the organization
  • Provide physician support to Clinical Coverage Review (CCR) operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC)
  • Collaborate with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefits coverage determinations
  • Conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed peer-to-peer
  • Use clinical knowledge in the application and interpretation of UHC medical policy and benefit document language in the process of clinical coverage review for UnitedHealth Care
  • Provide support for CCR nurses and non-clinical staff in multiple sites in a manner conducive to teamwork
  • Communicate and collaborate with network providers in pursuit of accurate and timely benefit determinations for plan participants; educates providers on benefit plans and UHC medical policy
  • Communicate and collaborate with other departments such as the Inpatient Concurrent Review team regarding coverage and other issues
  • Access clinical specialty panel to assist or obtain assistance in complex or difficult cases
  • Document clinical review findings, actions and outcomes in accordance with CCR policies, and regulatory and accreditation requirements
  • Actively participate as a key member of the CCR team in regular meetings and projects focused on communication, feedback, problem solving, process improvement, staff training and evaluation and sharing of program results
  • Provide clinical and strategic leadership when participating on national committees and task forces focused on achieving Clinical Coverage Review goals

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.

Posted: 2020-05-06 Expires: 2020-06-05

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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Market Medical Director - West Valley, UT

UnitedHealth Group
West Valley City, UT 84119

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