Join Optum as a Medical Director in Utilization Management to enhance health outcomes through clinical advocacy and support. Collaborate with a multidisciplinary team to ensure effective and cost-efficient medical care for members.
Key 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
Required Qualifications
M.D or D.O.
Board certification in Internal Medicine, Family Medicine, or Emergency Medicine
Willing to obtain additional 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
Preferred Qualifications
Board certification in either Gastroenterology, Cardiology or Endocrinology
Active unrestricted license to practice medicine in the state of Texas
Experience in utilization and clinical coverage review
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
Benefits & Perks
Comprehensive benefits packageIncentive and recognition programsEquity stock purchase401k contribution