Regional Medical Director | Focus on Patient Care with Optum

Ontario, CA

full-time
Outpatient

Primary Responsibilities:

  • Works primarily with the physician community around issues of patients, balancing business and clinical concerns.
  • Provides limited utilization management for outpatient medical, surgical and pharmacy activity. Participates in medical appeals activity.
  • Reviews all 2nd-level overturned cases related to medical necessity / investigational issues in the context of potential medical policy updates. Works with the Appeals area 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). Performs peer reviews on quality complaints, sentinel events, and quality-of-care referrals.
  • Serves as Physician Advisor for other areas within the company, including but not limited to Sales and Marketing, Underwriting, PHP, and Provider Services.
  • Provides medical leadership and advice for conformance with standards and guidelines for NCQA, URAC, state and federal regulators, and other accrediting bodies.
  • Travel to multiple IPA offices in designated region to meet with teams, collaborate with Physicians, coach and educate to improve overall quality outcomes; efficiencies of care and initiatives.

Qualifications:

  • Possess a current and unrestricted MD or DO license in California
  • Board certification in Internal Medicine, Family Medicine, Pediatrics, Emergency Medicine
  • Minimum 3 - 5 years of experience working as a Medical Director in a managed care setting with minimum three years of experience in utilization management, utilization review and prior authorization.
  • **Minimum 3-5 years of experience interacting with both group and IPA Physicians including experience....

For complete description tap [HERE][1]

[1]: https://www.jobsatoptumcare.com/job/R0078700/Regional-Medical-Director


Posted April 7, 2021