Medical Director – Orthopedic Surgery – Remote Position Available In Wake, North Carolina

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 diversity and inclusion, talented peers,comprehensive benefits and career development opportunities. Comemake an impact on the communities we serve as you help us advancehealth equity on a global scale. Join us to start Caring.

Connecting. Growing together. – Clinical Advocacy & Support has an unrelenting focus on thecustomer journey and ensuring we exceed expectations as we deliverclinical coverage and medical claims reviews. Our role is toempower providers and members with the tools and information neededto improve health outcomes, reduce variation in care, deliverseamless experience, and manage health care costs. The Medical Director provides physician support to EnterpriseClinical Services operations, the organization responsible for theinitial clinical 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 Director collaborates with a multidisciplinary team andis actively involved in the management of medical benefits. Thecollaboration often involves the member’s primary care provider orspecialist 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’ll enjoy the flexibility to work remotely • from anywherewithin the U.S. as you take on some tough challenges.

Primary Responsibilities:

Conduct coverage reviews based on individual member plan benefitsand national and proprietary coverage review policies, rendercoverage determinations Document clinical review findings, actions, and outcomes inaccordance with policies, and regulatory and accreditationrequirements Engage with requesting providers as needed in peer-to-peerdiscussions Be knowledgeable in interpreting existing benefit language andpolicies in the process of clinical coverage reviews Participate in daily clinical rounds as requested Communicate and collaborate with network and non-network providersin pursuit of accurate and timely benefit determinations for planparticipants while educating providers on benefit plans and medicalpolicy Communicate and collaborate with other internal partners Participate in holiday and call coverage rotation Obtain additional licenses as needed You’ll be rewarded and recognized for your performance in anenvironment that will challenge you and give you clear direction onwhat it takes to succeed in your role as well as providedevelopment for other roles you may be interested in.

RequiredQualifications:

M.D or D.O. Board certification in Orthopedic Surgery Active unrestricted license to practice medicine Ability to obtain additional licenses as needed 5+ years of clinical practice experience after completing residencytraining Sound understanding of Evidence Based Medicine (EBM) Solid PC skills, specifically using MS Word, Outlook, and Excel Proven ability to participate in holiday and call coveragerotation

Preferred Qualifications:

Experience in utilization and clinical coverage review Proven excellent oral, written, and interpersonal communicationskills, facilitation skills Proven data analysis and interpretation aptitude Proven innovative problem-solving skills Proven excellent presentation skills for both clinical andnon-clinical audiences •All employees working remotely will be required to adhere toUnitedHealth Group’s Telecommuter Policy The salary range for this role is $238,000 to $357,500 per year.

Salary Range is defined as total cash compensation at target. Theactual range and pay mix of base and bonus is variable based uponexperience and metric achievement. Pay is based on several factorsincluding but not limited to local labor markets, education, workexperience, certifications, etc. UnitedHealth Group complies withall minimum wage laws as applicable. In addition to your salary,UnitedHealth Group offers benefits such as, a comprehensivebenefits package, incentive and recognition programs, equity stockpurchase and 401k contribution (all benefits are subject toeligibility requirements). No matter where or when you begin acareer with UnitedHealth Group, you’ll find a far-reaching choiceof benefits and incentives.

Application Deadline:

This will be posted for a minimum of 2business days or until a sufficient candidate pool has beencollected. Job posting may come down early due to volume ofapplicants. At UnitedHealth Group, our mission is to help people live healthierlives and make the health system work better for everyone. Webelieve everyone-of every race, gender, sexuality, age, locationand income-deserves the opportunity to live their healthiest life.

Today, however, there are still far too many barriers to goodhealth which are disproportionately experienced by people of color,historically marginalized groups and those with lower incomes. Weare committed to mitigating our impact on the environment andenabling and delivering equitable care that addresses healthdisparities and improves health outcomes – an enterprise priorityreflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employerunder applicable law and qualified applicants will receiveconsideration for employment without regard to race, nationalorigin, religion, age, color, sex, sexual orientation, genderidentity, disability, or protected veteran status, or any othercharacteristic protected by local, state, or federal laws, rules,or regulations. UnitedHealth Group is a drug-free workplace. Candidates arerequired to pass a drug test before beginning employment.