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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 Medical Director 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.
Position in this function is responsible for multiple medical management functions including but not limited to Utilization Management and Quality Management functions. Collaborate with Physicians and other providers to improve the quality care, affordability, and member satisfaction.
Position Highlights:
- Office Schedule: Monday - Friday
- 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)
- Provides medical expertise for traditional utilization management services and resources for outpatient medical, surgical, and pharmacy activity
- Perform medical reviews and determinations (i.e., brief written criteria/reasons for determination) of Utilization Management and Pharmacy, prior authorizations, concurrent, retrospective authorizations, grievances, and gap appeals
- Lead regional special projects under direction of Regional CMO
- Participate and provide physician advice to Medical Management interdisciplinary care teams that are inclusive of nurses, physicians, social works, care coordinators, and pharmacists
- Educate and communicates with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization, and effective resource management
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:
- Current and unrestricted MD or DO license in California
- Board certification in their chosen specialty
- 5+ years of clinical practice experience
- 2+ years of experience working in a managed care setting
- 2+ years of experience in utilization management, utilization review and prior authorization
- Experience working with clinical information technology systems
- Proficiency working with data analytics, reporting and presentations
- Proven excellent communication and time management skills
- Proven comfortable presenting in group setting
About OptumCare:
At OptumCare, we’ve found that putting clinicians at the center of care is the best way to improve lives. Our physician-led organization is one of the most dynamic and progressive health care organizations in the world, serving over 17 million people through more than 45,000 aligned physicians and 9,000 advanced practice clinicians. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation. Learn more at www.workatoptum.com.
Would you thrive with OptumCare?
- Do you practice evidence-based medicine?
- Are you seeking a practice focused on patient-centered quality care, not volume?
- Are you a team player - comfortable delegating and empowering teams?
- Are you constantly seeking better ways to do things?
- Do you want to be part of something better?
California Residents Only: The salary range for this role is $286,104 to $397,743 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).
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.
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