Associate Medical Director, UM Reviewer - Remote
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Life Changing Work
Want to make a real difference in the lives you touch? LOOK NO FURTHER.
Optum is a physician-led, close-knit team that has been long-respected in Southern California. We are passionate about patients. We are leading the state of California toward better healthcare practices. And we are looking for amazing doctors like you.
As part of our continued growth, Optum is looking for Associate Medical Director / UM Reviewer, Physician to join our regional team in Orange County. The Clinicians we seek are those who practice medicine with a focus on patient care, not volume. We want our Clinicians to take the time needed to truly address the patient's needs. If you're looking to join a physician-led community that is making a difference in healthcare, Optum is the place for you.
If you are located in Irvine, CA, you will have the flexibility to work remotely* as you take on some tough challenges.
Position Highlights:
Schedule: Monday - Friday, remote and office based
Call: 1:4 (approximately 2-3 hours over weekend)
Timely review of requests for service; performing pre-service authorization review and post- service / claims review and make determination based on medical necessity and appropriateness of care within established guidelines
Clearly and accurately document all communication and decision-making and meet appropriate turn-around times for clinical reviews
Conduct timely peer-to-peer discussion with providers to clarify clinical information and explain review outcomes, including feedback on alternate treatment based on medical necessity criteria
Adhere to regulatory, health plan, and clinical guidelines for denials
Work collaboratively with UM Review Physicians and Care Management team
Attend monthly Utilization Management meeting for region
Participate in weekly interdisciplinary team calls
Participate in health plan joint operations meetings and audits as necessary
Position will cover designated regions and may require occasional travel to sites or regional office
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Unrestricted CA Medical License
Current CA DEA certificate prior to start date
Current Board Certification Family/Internal Medicine, Pediatrics
3+ years clinical experience
2+ years of experience in medical group, health plan setting; prior authorization review experience
Knowledge of health plan and regulatory requirements
Excellent working knowledge of CMS regulations
Proficient with CPT and ICD-10 codes
Computer proficient
Proven excellent oral and written communication skills
Proven ability to work independently
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
California Residents Only: The salary range for this role is $273,584 to $380,852 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 local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Apply Now
Life Changing Work
Want to make a real difference in the lives you touch? LOOK NO FURTHER.
Optum is a physician-led, close-knit team that has been long-respected in Southern California. We are passionate about patients. We are leading the state of California toward better healthcare practices. And we are looking for amazing doctors like you.
As part of our continued growth, Optum is looking for Associate Medical Director / UM Reviewer, Physician to join our regional team in Orange County. The Clinicians we seek are those who practice medicine with a focus on patient care, not volume. We want our Clinicians to take the time needed to truly address the patient's needs. If you're looking to join a physician-led community that is making a difference in healthcare, Optum is the place for you.
If you are located in Irvine, CA, you will have the flexibility to work remotely* as you take on some tough challenges.
Position Highlights:
Schedule: Monday - Friday, remote and office based
Call: 1:4 (approximately 2-3 hours over weekend)
Timely review of requests for service; performing pre-service authorization review and post- service / claims review and make determination based on medical necessity and appropriateness of care within established guidelines
Clearly and accurately document all communication and decision-making and meet appropriate turn-around times for clinical reviews
Conduct timely peer-to-peer discussion with providers to clarify clinical information and explain review outcomes, including feedback on alternate treatment based on medical necessity criteria
Adhere to regulatory, health plan, and clinical guidelines for denials
Work collaboratively with UM Review Physicians and Care Management team
Attend monthly Utilization Management meeting for region
Participate in weekly interdisciplinary team calls
Participate in health plan joint operations meetings and audits as necessary
Position will cover designated regions and may require occasional travel to sites or regional office
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Unrestricted CA Medical License
Current CA DEA certificate prior to start date
Current Board Certification Family/Internal Medicine, Pediatrics
3+ years clinical experience
2+ years of experience in medical group, health plan setting; prior authorization review experience
Knowledge of health plan and regulatory requirements
Excellent working knowledge of CMS regulations
Proficient with CPT and ICD-10 codes
Computer proficient
Proven excellent oral and written communication skills
Proven ability to work independently
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
California Residents Only: The salary range for this role is $273,584 to $380,852 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 local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Apply Now