Medical Director - Clinical Advocacy and Support ENT or Internal Medicine preferred - Remote
Optum
Atlanta, GA
1 day ago
$238,000 - $357,500
Job Description
Join Optum as a Medical Director, where you'll lead clinical advocacy and support efforts that directly impact health outcomes. Collaborate with a multidisciplinary team to ensure quality medical care and improve patient experiences while working remotely from anywhere in the U.S.
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
Call coverage rotation
Required Qualifications
M.D or D.O
Active unrestricted license to practice medicine
Board certification in an ABMS specialty with Internal Medicine, ENT, Hematology - Oncology, General Surgery, Rheumatology, or PM&R preferred
3+ years of clinical practice experience after completing residency training
Demonstrated sound understanding of Evidence Based Medicine (EBM)
Proven solid PC skills, specifically using MS Word, Outlook, and Excel
Preferred Qualifications
CA, OR, WA or AZ licensure or willing to obtain
Experience in utilization and clinical coverage review
Proven excellent oral, written, and interpersonal communication skills, facilitation skills
Proven data analysis and interpretation aptitude
Proven innovative problem-solving skills
Proven excellent presentation skills for both clinical and non-clinical audiences
Benefits & Perks
Comprehensive benefits packageIncentive and recognition programsEquity stock purchase401k contribution