Sr. Medical Director of Medical Management - Telecommute

Cypress, CA


Primary Responsibilities:

  • Program development including:
    • Workflow development
      • Driving efficiency
      • Outcomes and improved results
      • Standardization of process
    • Ensuring regulatory adherence (primarily Medicare Advantage)
    • Relationship building within operations and with CDO contacts
    • Primary liaison between payor / local market (CDO) and clinical decision making (UM) teams for E2E processes
    • Participation in pre-delegation audits, annual audits as needed
  • Function as clinical leader SME with payors and as needed regulators (when appropriate for Risk bearing entity audits (RBE) r/t UM and DM
  • Function as identified clinical leader (MD) for Optum care Clinical Performance Medical management processes
  • Clinical liaison with Care Delivery Organizations for end to end medical management capabilities
  • Full functional knowledge of CMS, NCQA and URAC UM and population health requirements
  • Demonstrates and role models how to work effectively in a fully matrixed organization
  • Thought leader to validate technology tools and capabilities that support medical management processes

Required Qualifications:

  • MD or DO de ...For complete description tap [HERE][1]

Colorado Residents Only: The salary range for Colorado residents is $293,200 to $324,800. 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. 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.


Posted June 5, 2021