Medical Director - Clinical Review - Remote

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.

Clinical Excellence, a national OptumCare team, is currently seeking an experienced National Medical Director to join our growing Value Innovations efforts. This key Physician will provide expertise and leadership on population, specifically Clinical Documentation Review with expertise in application of DRG coding and clinical operations. This position joins a team in the process of rapid expansion of both new and existing value-based initiatives and programs.

At Clinical Excellence, our mission is effective implementation, monitoring, & execution of clinical programs that improve the patient & provider experience, while delivering superior outcomes at a sustainable cost. We aim to achieve repeatable, practical, sustainable, & compliant solutions that deliver value to the OptumCare businesses. We serve as national support for our internal physician groups in achieving clinical improvement or capability-building initiatives.

Primary Responsibilities:

• Provide consistent high-quality DRG-based clinical reviews within the Optum Enterprise Innovative DRG Clinical Review program and be an excellent written and spoken communicator (e.g., communication letters, engagement in peer-to-peer conversations)
• Close collaboration with a team of medical directors, nurse coders, and operations team to deliver DRG Clinical Review performance
• Identifying opportunities expand and optimize program success in collaboration with other programs, such as hospital utilization management and claims adjudication teams
• Collaborate with IT partners to implement AI enhancements within programs
• Participate in other Value Innovation programs, as assigned
• Change Management
• Participate in the cross collaboration with regional care delivery organizations through OH and Payment Integrity
• Closely partner with IT on development and implementation of program delivery
• Emotional Maturity and EQ
• Establishing strong and lasting, trust-based relationships within team and external partners
• Foster exemplary teamwork and strengthen a culture of continuous improvement and accountability
• Take initiative and self-start attitude to approach problems with energy and passion
• Demonstrate preference for working in a tight-knit team environment with diverse professional groups

Required Qualifications:

• M.D. or D.O. with an active, unrestricted medical license
• Board certified in adult primary care fields (e.g. Internal Medicine, Family Medicine, Hospitalist) or related subspecialties
• 3+ years of clinical experience post residency

Preferred Qualification:

• Experience with DRG clinical documentation and/or coding team collaboration within a hospital system or payor
• Experience in chart review (DRG, UM, PA) or prior role as hospital physician advisor

About Optum

Optum is the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare. We’re a global organization that’s evolving health care so everyone can have the opportunity to live their healthiest life. With our hands across all aspects of health, we'll provide you with a rewarding career that enables you to grow in the directions that best fit your passions. This is your opportunity to be part of a team that’s dedicated to Caring. Connecting. Growing together.