Medical Director-Clinical Advocacy and Support - Remote
Optum
Raleigh, NC
16 days ago
$238,000 - $357,500
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Job Description
Join Optum as a Medical Director to enhance health outcomes through clinical advocacy and support. Collaborate with a multidisciplinary team to manage medical benefits and ensure quality care for members, all while enjoying the flexibility of remote work.
Key Responsibilities
Conduct coverage reviews based on individual member plan benefits
Document clinical review findings, actions, and outcomes
Engage with requesting providers in peer-to-peer discussions
Interpret existing benefit language and policies in clinical coverage reviews
Participate in daily clinical rounds as requested
Communicate with network and non-network providers for benefit determinations
Collaborate with other internal partners
Participate in call coverage rotation
Required Qualifications
M.D or D.O.
Active unrestricted license to practice medicine
Board certification in an ABMS specialty
5+ years of clinical practice experience after completing residency training
Sound understanding of Evidence Based Medicine (EBM)
Proven solid PC skills, specifically using MS Word, Outlook, and Excel
Ability to participate in call coverage rotation
Preferred Qualifications
Licensed in AZ, CA, MA, MN or TX
Board certified in family medicine or internal medicine
Experience in utilization and clinical coverage review
Proven excellent oral, written, and interpersonal communication 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