Associate Medical Director, Beaver Medical Group - Optum

Redlands, CA

full-time
Outpatient

JOB DESCRIPTION

The Associate Medical Director is responsible for many Medical Management functions that including but not limited to Utilization Management and Quality Management functions. The Associate Medical Director is also responsible for working with physicians and other providers to improve the quality, affordability, and member satisfaction.

Primary Responsibilities:

  • Provides utilization management for outpatient medical, surgical and pharmacy activity.
  • Participates in medical appeals activity. May be asked to review 2nd-level overturned cases related to medical necessity/investigational issues in the context of potential medical policy updates.
  • Works with the Appeals unit on appeals related to utilization management issues.
  • Provides medical leadership and physician advice to the quality management area with respect to quality improvement studies, quality improvement committees, primary care assessments (both office-site assessments and medical record document reviews).
  • Collaborates and engages with the physicians and practices in order to implement strategies to improve the completion rate of annual wellness visits.
  • Collaborates with the Quality team and physicians and practices to implement strategies to improve Quality STARs measures.


Posted July 9, 2021