Urgent Search! Utilization Management Medical Director, Genetics – Remote Position Available In Suffolk, Massachusetts

Job Description:

Optum is a global organization that delivers care, aided bytechnology to help millions of people live healthier lives. Thework you do with our team will directly improve health outcomes byconnecting people with the care, pharmacy benefits, data andresources they need to feel their best. Here, you will find aculture guided by inclusion, talented peers, comprehensive benefitsand career development opportunities. Come make an impact on thecommunities we serve as you help us advance health optimization ona global scale. Join us to start Caring. Connecting. Growingtogether. Clinical Advocacy & Support has an unrelenting focus onthe customer journey and ensuring we exceed expectations as wedeliver clinical coverage and medical claims reviews. Our role isto empower providers and members with the tools and informationneeded to improve health outcomes, reduce variation in care,deliver seamless experience, and manage health care costs. TheMedical Director provides physician support to Enterprise ClinicalServices operations, the organization responsible for the initialclinical review of service requests for Enterprise ClinicalServices. The Medical Director collaborates with EnterpriseClinical Services leadership and staff to establish, implement,support, and maintain clinical and operational processes related tobenefit coverage determinations, quality improvement and costeffectiveness of service for members. The Medical Director’sactivities primarily focus on the application of clinical knowledgein various utilization management activities with a focus onpre-service benefit and coverage determination or medical necessity(according to the benefit package), and on communication regardingthis process with both network and non-network physicians, as wellas other Enterprise Clinical Services. The Medical Directorcollaborates with a multidisciplinary team and is actively involvedin the management of medical benefits for all lines of business.

The collaboration often involves the member’s primary care provideror specialist physician. It is the primary responsibility of themedical director to ensure that the appropriate and mostcost-effective quality medical care is provided to members. You’llenjoy the flexibility to work remotely

• from anywhere within theU.

S. as you take on some tough challenges.

PrimaryResponsibilities:

• Conduct coverage reviews based on individualmember plan benefits and national and proprietary coverage reviewpolicies, render coverage determinations
• Document clinical reviewfindings, actions, and outcomes in accordance with policies, andregulatory and accreditation requirements
• Engage with requestingproviders as needed in peer-to-peer discussions
• Be knowledgeablein interpreting existing benefit language and policies in theprocess of clinical coverage reviews
• Participate in dailyclinical rounds as requested
• Communicate and collaborate withnetwork and non-network providers in pursuit of accurate and timelybenefit determinations for plan participants while educatingproviders on benefit plans and medical policy
• Communicate andcollaborate with other internal partners
• Call and holidaycoverage rotation You’ll be rewarded and recognized for yourperformance in an environment that will challenge you and give youclear direction on what it takes to succeed in your role as well asprovide development for other roles you may be interested in.

Required Qualifications:

• M.D or D.O
• Active unrestricted licenseto practice medicine
• Board certification in Internal Medicine orFamily Medicine; to include genetics experience
• Ability to obtainadditional licenses as needed
• Sound understanding of EvidenceBased Medicine (EBM)
• Solid PC skills, specifically using MS Word,Outlook, and Excel
• Ability to participate in rotational holidayand call coverage

Preferred Qualifications:

• 5 years of clinicalpractice experience after completing residency training
• Experience in utilization and clinical coverage review
• Provenexcellent oral, written, and interpersonal communication skills,facilitation skills
• Proven data analysis and interpretationaptitude
• Proven innovative problem-solving skills
• Provenexcellent presentation skills for both clinical and non-clinicalaudiences
• All employees working remotely will be required toadhere to UnitedHealth Group’s Telecommuter Policy The salary rangefor this role is $238,000 to $357,500 annually based on full-timeemployment.

Salary Range is defined as total cash compensation attarget. The actual range and pay mix of base and bonus is variablebased upon experience and metric achievement. Pay is based onseveral factors including but not limited to local labor markets,education, work experience, certifications, etc. UnitedHealth Groupcomplies with all minimum wage laws as applicable. In addition toyour salary, UnitedHealth Group offers benefits such as, acomprehensive benefits package, incentive and recognition programs,equity stock purchase and 401k contribution (all benefits aresubject to eligibility requirements). No matter where or when youbegin a career with UnitedHealth Group, you’ll find a far-reachingchoice of benefits and incentives.

Application Deadline:

This willbe posted for a minimum of 2 business days or until a sufficientcandidate pool has been collected. Job posting may come down earlydue to volume of applicants. At UnitedHealth Group, our mission isto help people live healthier lives and make the health system workbetter for everyone. We believe everyone-of every race, gender,sexuality, age, location and income-deserves the opportunity tolive their healthiest life. Today, however, there are still far toomany barriers to good health which are disproportionatelyexperienced by people of color, historically marginalized groupsand those with lower incomes. We are committed to mitigating ourimpact on the environment and enabling and delivering equitablecare that addresses health disparities and improves health outcomes

• an enterprise priority reflected in our mission.

UnitedHealthGroup is an Equal Employment Opportunity employer under applicablelaw and qualified applicants will receive consideration foremployment without regard to race, national origin, religion, age,color, sex, sexual orientation, gender identity, disability, orprotected veteran status, or any other characteristic protected bylocal, state, or federal laws, rules, or regulations. UnitedHealthGroup is a drug-free workplace. Candidates are required to pass adrug test before beginning employment.