Note: The job is a remote job and is open to candidates in USA. Optum is a global organization focused on improving health outcomes through technology and care delivery. The Medical Director for Pediatrics and Internal Medicine will support clinical operations, conducting coverage reviews and collaborating with healthcare providers to ensure cost-effective quality medical care. This role involves engaging in clinical rounds, communicating with providers, and participating in coverage determinations to enhance member care.

Responsibilities

• Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
• Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements
• Engage with requesting providers as needed in peer-to-peer discussions
• Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
• Participate in daily clinical rounds as requested
• Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
• Communicate and collaborate with other internal partners
• Participate in holiday and call coverage rotation

Skills

• M.D or D.O
• Board certification in Internal Medicine and Pediatrics through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
• Active unrestricted medical license and ability to obtain additional state medical licenses as needed
• 5+ years of clinical practice experience after completing residency training
• Proven sound understanding of Evidence Based Medicine (EBM)
• Proven solid PC skills, specifically using MS Word, Outlook, and Excel
• Ability to participate in rotational holiday and call coverage
• Experience in utilization and clinical coverage review
• Reside in Nebraska or Texas
• Licensure in TX. IN, KS, NE, AZ, WA, FL or a compact license
• Proven excellent oral, written, and interpersonal communication skills, facilitation skills
• Demonstrated data analysis and interpretation aptitude
• Proven innovative problem-solving skills
• Demonstrated presentation skills for both clinical and non-clinical audiences
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Benefits

• A comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)
• Flexibility to work remotely rom anywhere within the U.S.

Company Overview

Company H1B Sponsorship