21 days old

Medical Director, Clinical Analysis and Consulting - West Valley, UT - 941641

West Valley City, UT 84119
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  • Job Code
    941641

Optum is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

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OptumCare is seeking aMarket Medical Directorto join our Clinical Analysis and Consulting Team in West Valley, UT.You will have the opportunity to drive measurable 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.

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Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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Primary Responsibilities:

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  • This role will require you to be out in the field with daily travel within the Salt Lake City market, developing and maintain collegial relationshipswith contracted Providers in efforts to support the business efforts of the organization
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  • Provide physician support to Clinical Coverage Review (CCR) operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC)
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  • Collaborate with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefits coverage determinations
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  • 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
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  • 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
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  • Provide support for CCR nurses and non-clinical staff in multiple sites in a manner conducive to teamwork
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  • 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
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  • Communicate and collaborate with other departments such as the Inpatient Concurrent Review team regarding coverage and other issues
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  • Access clinical specialty panel to assist or obtain assistance in complex or difficult cases
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  • Document clinical review findings, actions and outcomes in accordance with CCR policies, and regulatory and accreditation requirements
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  • 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
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  • Provide clinical and strategic leadership when participating on national committees and task forces focused on achieving Clinical Coverage Review goals
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Youll 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.

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Required Qualifications:

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  • M.D. or D.O.
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  • Active, unrestricted Utah Medical License
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  • Current Board Certification in ABMS or AOA specialty
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  • 5+ years of clinical practice experience post residency
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  • 2+ years hands-on experience in utilization and coverage review in a health plan with commercial and or Medicare Advantage membership
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  • Experience as a practicing physician in value based and/or Global Risk Model
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  • Ability to travel within the Salt Lake market the majority of the time
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Preferred Qualifications:

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  • Solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles
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  • Supervisory skills, including clinical mentoring and coaching expertise
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  • Project management background
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  • Team player and strong teambuilding skills
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  • Creative problem-solving skills
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  • Excellent presentation skills for both clinical and non-clinical audiences
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Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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Colorado Residents Only: The salary range for Colorado residents is $110,200 to $211,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, youll find a far-reaching choice of benefits and incentives

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Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords:Market Medical Director, West Valley, UT, Utah

Posted: 2021-07-03 Expires: 2021-08-02

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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Medical Director, Clinical Analysis and Consulting - West Valley, UT - 941641

UnitedHealth Group
West Valley City, UT 84119

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