Medical Director OptumRx Prior Authorization and Appeals - Telecommute

Company: Optum
Location: Sugar Land
Posted on: February 18, 2021

Job Description:

Medical Director opening in Sugar Land, Texas. This and other physician jobs brought to you by DocCafe.com If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:

• Work to improve patient care quality and promote evidence-based medicine
• Support the OptumRx Prior Authorization and Appeals service by performing physician level drug utilization reviews and rendering clinical coverage determinations.
• Consult with physician peer prescribers on patient medication needs and clinical appropriateness
• Support initiatives that enhance quality throughout our prior authorization utilization management programs
• Ensure the right service is provided at the right time for each member
• Work in a collaborative environment within a medical director team and other clinical professionals focusing on patient care medication management, clinical coverage review, and appeals clinical reviewSuccess in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting.
  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:
  • MD or DO degree
  • Active, unrestricted physician state license
  • Current board certification in ABMS or AOA specialty
  • 5+ years of clinical practice experience post residency
  • Experience providing coverage reviews, applying evidence-based medicine (EBM) and managed care principles
  • Experience referencing and applying drug compendia and evidence based medicine information systems
  • Proficiency with MS Office applications, navigating multiple screens
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking ordersPreferred Qualifications: Active and unrestricted physician license in Arkansas and/or FloridaCurrent board certification in Cardiology, Dermatology, or NeurologyHands-on utilization and/or quality management experienceProject management or active project participation experienceSubstantial experience in using electronic clinical systems Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) The salary range for Colorado residents is $254,600 to $295,200. The 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 education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance. *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy 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. Job Keywords: Physician executive, clinician, utilization management, Milliman, Interqual, doctor, appeals, clinical quality, clinical coverage review, telecommute, telecommuter, telecommuting, work from home, WFH, work at home, remote Keyphrases: health administration jobs, medical director jobs, hospital administration jobs, hospital administrative jobs, healthcare administration jobs, administration jobs, healthcare administrator jobs, medical administration jobs, chief medical officer jobs, medical director position jobs, associate medical director jobs, medical ceo jobs, healthcare ceo jobs, medical administrative jobs, executive director jobs

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