Medical Director Otolaryngology - Remote
Company: UnitedHealth Group
Location: Chattanooga
Posted on: October 29, 2024
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Job Description:
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 diversity and inclusion, talented peers,
comprehensive benefits and career development opportunities. Come
make an impact on the communities we serve as you help us advance
health equity on a global scale. Join us to start Caring.
Connecting. Growing together. -
Clinical Advocacy & Support has an unrelenting focus on the
customer journey and ensuring we exceed expectations as we deliver
clinical coverage and medical claims reviews. Our role is to
empower providers and members with the tools and information needed
to improve health outcomes, reduce variation in care, deliver
seamless experience, and manage health care costs.
The Medical Director provides physician support to Enterprise
Clinical Services operations, the organization responsible for the
initial clinical review of service requests for Enterprise Clinical
Services. -The Medical Director collaborates with Enterprise
Clinical Services leadership and staff to establish, implement,
support, and maintain clinical and operational processes related to
benefit coverage determinations, quality improvement and cost
effectiveness of service for members. The Medical Director's
activities primarily focus on the application of clinical knowledge
in various utilization management activities with a focus on
pre-service benefit and coverage determination or medical necessity
(according to the benefit package), and on communication regarding
this process with both network and non-network physicians, as well
as other Enterprise Clinical Services.
The Medical Director collaborates with a multidisciplinary team and
is actively involved in the management of medical benefits. The
collaboration often involves the member's primary care provider or
specialist physician. It is the primary responsibility of the
medical director to ensure that the appropriate and most
cost-effective quality medical care is provided to members.
You'll enjoy the flexibility to work remotely * from anywhere
within the U.S. as you take on some tough challenges. -
Primary Responsibilities:
Conduct coverage reviews based on individual member plan benefits
and national and proprietary coverage review policies, render
coverage determinations
Document clinical review findings, actions, and outcomes in
accordance with policies, and regulatory and accreditation
requirements
Engage with requesting providers as needed in peer-to-peer
discussions
Be knowledgeable in interpreting existing benefit language and
policies in the process of clinical coverage reviews
Participate in daily clinical rounds as requested
Communicate and collaborate with network and non-network providers
in pursuit of accurate and timely benefit determinations for plan
participants while educating providers on benefit plans and medical
policy
Communicate and collaborate with other internal partners
Call coverage rotation
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. Required
Qualifications:
M.D or D.O.
Board certification in Otolaryngology
Active unrestricted license to practice medicine
5+ years of clinical practice experience in Otolaryngology after
completing residency training
Sound understanding of Evidence Based Medicine (EBM)
Solid PC skills, specifically using MS Word, Outlook, and Excel
Preferred Qualifications:
Licensure in Texas or Tennessee
Experience in utilization and clinical coverage review
Proven excellent oral, written, and interpersonal communication
skills, facilitation skills
Proven data analysis and interpretation aptitude
Proven innovative problem-solving skills
Proven excellent presentation skills for both clinical and
non-clinical audiences
*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New
York, Rhode Island, Washington or Washington, D.C. Residents Only:
-The salary range for this role is $286,104 to $397,743 annually.
Salary Range is defined as total cash compensation at target. The
actual range and pay mix of base and bonus is variable based upon
experience and metric achievement. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. 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, you'll find a far-reaching choice
of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2
business days or until a sufficient candidate pool has been
collected. Job posting may come down early due to volume of
applicants.
At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission.
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.
UnitedHealth Group is a drug-free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: UnitedHealth Group, Alpharetta , Medical Director Otolaryngology - Remote, Healthcare , Chattanooga, Georgia
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