Medical Director - Post-Acute Care Internist - Remote in Missouri

Primary Responsibilities:

• Provide daily utilization oversight and external communication with network physicians and hospitals
• Responsible for daily UM reviews - authorization and denial reviews
• Conduct peer to peer conversations for clinical case reviews as needed
• Conduct provider telephonic review and discussion, share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
• Communicate effectively with providers to ensure the successful administering of Optum’s services
• Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
• Collaborate with Team to ensure a coordinated approach toward our member’s health care
• the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
• Provide leadership and guidance to maximize cost management through close coordination with network and provider contracting
• Regularly meet with Optum’s leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues
• Provide input on local needs for Analytics Team and Care Management Team to better enhance Optum’s products and services
• Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME
• Perform other duties and responsibilities as required, assigned, or requested

Required Qualifications:

• Graduate of a recognized accredited medical school
• Current, unrestricted medical license and residency in the state of Missouri
• Board certified in a recognized ABMS specialty
• Board Certified in Internal Medicine
• 3+ years of experience practicing in an acute inpatient environment, where dealing with managed care organizations made up at least half of inpatient practice
• Proven understanding of population-based medicine with preference given to significant experience with the Medicare, Medicaid, and Commercial populations
• Proficient computer skills
• Proven working knowledge of changing U.S. payer and provider landscape
• Dedicated office/work area established that is separated from other living areas and provides privacy
• Reside in a location that can receive a high-speed internet connection

Preferred Qualifications:

• Ability to work with others while completing multiple tasks simultaneously and successfully
• Ability to complete assignments with reasonable oversight, direction, and supervision
• Ability to be highly motivated, flexible, and adaptable to working in a fast-paced, dynamic environment
• Proven solid interpersonal skills and necessary business acumen to communicate and build positive relationships with management
• Ability to positively interact with other clinicians, senior management, and all levels of medical and non-medical professionals
• Possess a high level of organizational skills, self- motivation, and ability to manage time independently
• Proven excellent organizational, verbal, and written communication and presentation skills
• Proven excellent analytic skills
• Ability to quickly adapt to change and drive innovation within team and market
• Ability to work across functions and businesses to achieve business goals
• Ability to develop and maintain positive customer and provider relationships