Medical Director - Clinical Advocacy and Support ENT or Internal Medicine preferred - Remote
Optum
Bell Gardens, CA
16 days ago
$238,000 - $357,500
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Job Description
Join Optum as a Medical Director, where you'll lead clinical advocacy and support initiatives to enhance health outcomes and manage medical benefits. Collaborating with a multidisciplinary team, you will ensure effective coverage determinations and empower both providers and members. Enjoy the flexibility of remote work while making a significant impact in healthcare delivery.
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 accurate benefit determinations
Collaborate with 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 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
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