Optum

Medical Director, Utilization Management - Remote

Nashville, TN

full-time
Non clinical

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.

We are currently seeking an Inpatient Care Management Medical Director to join our Optum team. This team is responsible for conducting acute level of care and length of stay reviews for medical necessity for our members being managed within the continuum of care. Our clients include local and national commercial employer, Medicare, and state Medicaid plans. The Medical Directors work with groups of nurses and support staff to manage inpatient care utilization at a hospital, market, regional or national level.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Participate in telephonic outreach for collaboration with treating providers. This will include discussion of evidence - based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expenses
  • Responsible to collaborate with operational and business partners on clinical and quality initiatives at the site and customer level to address customer expectations
  • Is grounded in the use and application of evidence-based medicine (EBM) such as InterQual care guidelines and criteria review
  • Occasionally, may participate in periodic market oversight meetings with the outward facing Chief Medical Officers, network contractors, nurse management and other internal managers
  • Maintain proficiency in all required software and platforms

Required Qualifications:

  • MD or DO with an active, unrestricted medical license
  • Current Board Certification in an ABMS or AOBMS specialty
  • 5+ years of clinical practice experience post residency
  • Private home office and access to high-speed Internet
  • Technical proficiency in computer software and systems

Preferred Qualifications:

  • 2+ years managed care, Quality Management experience and/or administrative leadership experience
  • Prior UM experience
  • Clinical experience within the past 2 years

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $248, 582 to $338, 965 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 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, you’ll find a far-reaching choice of benefits and incentives.

Location Insights

  • A

    Access to Parks

  • A-

    Access to Outdoor Activities

  • A-

    Access to Restaurants

  • A-

    Overall

  • B+

    Commute

  • B-

    Cost of Living

  • Total Population

    663,750

  • Median Rent

    $1,100

  • Median Home Value

    $239,000

  • Median Income

    $59,828

Posted February 27, 2024