Medical Director, Pharmacy Prior Authorization Review- 100% Telecommute

Costa Mesa, CA

full-time
Inpatient and outpatient

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 review

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
  • Solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles
  • UM experience, doing UM reviews

Preferred Qualifications:

  • Hands-on utilization and/or quality management experience
  • Project management or active project participation experience
  • Substantial experience in using electronic clinical systems


Posted December 11, 2021