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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