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UnitedHealth Group

UnitedHealth Group is looking for a Regional Medical Director, NAMM Optum – Ontario, CA  #JobPostingsNearPagosaSprings #PagosaSpringsJobMarket #DirectorJobsPagosaSprings #MedicalJobsPagosaSprings

We at NAMM, a part of OptumCare, deliver a clearly differentiated level of outcome andservice adherence. Come join our team and add to our bench strength as weexecute on managed care 2.0 bringing together revenue optimization, appropriateutilization, unit cost management and strategic acquisitions. Quality caresaves money without exception.Careers atOptumCare.We’re on a mission to change the face of health care. As the largest health andwellness business in the US, we help 58 million people navigate the health caresystem, finance their health care needs and achieve their health and well-beinggoals. Fortunately, we have a team of the best and brightest minds on theplanet to make it happen. The MedicalDirector interacts with Physicians and IPA staff to ensure that patientneeds are met in an efficient and medically appropriate manner. The MedicalDirector of is responsible for the Medical Management functions that include vendorrelations, Utilization Management and business development. In addition, thisrole provides prime management, oversight anddevelopment for major program and functional areas within Medical Management.These include medical policy, patient centered medical home, Medicaid, Healthand Wellness, population management, and reporting capabilities. The MedicalDirector is also responsible for working with physicians and other providers,especially PCMH practices, to improve the quality and efficiency of care in thenetwork and integrate these providers into clinical initiatives.Primary Responsibilities:Works primarily with  the physician community around issues of particular 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.Acts as liaison for communication with physicians, hospitals, and other providers in the community.Reviews customer service and claims inquiries.RequiredQualifications:Possess a current and unrestricted MD or DO license in California3 or more years of experience working as a Medical Director in a managed care setting3 or more years of experience in utilization management, utilization review and prior authorization 3 or more years of experience interacting with both group and IPA PhysiciansExperience withinpatient/hospitalist managementExperience with and comfort level insupervising Advanced Practice CliniciansBoard certification in their chosen specialtyIfyou need to enter a work site for any reason, you will be required to screenfor symptoms using the ProtectWell mobile app, Interactive Voice Response(i.e., entering your symptoms via phone system) or similar UnitedHealthGroup-approved symptom screener. When in a UnitedHealth Group building,employees are required to wear a mask in common areas. In addition, employeesmust comply with any state and local masking ordersPreferred Qualifications:Prior experience working with clinical information technology systemsPublic presentation skillsWhat’s the first thing that happenswhen one of the most successful groups in Riverside County comes together witha global leader in health care? Opportunity. With NAMM joining OptumCare andthe UnitedHealth Group family of companies, people like you will findincreasing levels of challenge, impact and professional success. With a vibrantnetwork of hospitals and urgent care centers, we’re changing health care forthe better by improving access to affordable, high quality care, and workingtogether to improve the patient experience. That takes passion, commitment,intense focus and the ability to contribute effectively in a highlycollaborative team environment. Are you with us? Learn more about this excitingopportunity to do your life’s best work.(sm)Diversity creates a healthier atmosphere: UnitedHealth Group is an EqualEmployment Opportunity/Affirmative Action employer and all qualified applicantswill receive consideration for employment without regard to race, color,religion, sex, age, national origin, protected veteran status, disabilitystatus, sexual orientation, gender identity or expression, marital status,genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to passa drug test before beginning employment.Job Keywords: Medical Director, MD,DO, managed care, UM, Utilization Management, CM, Case Management, IPA,clinical informatics, Ontario, Riverside, San Bernardino, San Diego, CA, Telecommute Recommended SkillsMedicaidUtilization ManagementManaged CareAppealsClaimsSalesRecommended JobsMedical DirectorAtlanta,GaMedical Director, Atlanta,GaRegional Medical Director, NAMM Optum – Ontario, CAUnitedHealth GroupWork From HomeFull-TimeBehavioral Medical Director Part- Time TelecommuteUnitedHealth GroupAtlantaUtilization Management Medical Director – WellMed – San Antonio, TXUnitedHealth GroupAtlanta

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