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Utilization Management Medical Director, Genetics - Remote

Optum

Edina, MN
16 days ago
$238,000 - $357,500

This Job Position Has Expired

This job listing is no longer available for applications. The position may have been filled or the posting period has ended.

Job Description

As a Utilization Management Medical Director, Genetics at Optum, you'll lead clinical reviews, ensuring quality care and cost-effectiveness for members. Collaborate with healthcare providers and internal teams to optimize health outcomes and streamline processes. Enjoy the flexibility of remote work while making a significant impact in healthcare.

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 during 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 and holiday coverage rotation

Required Qualifications

  • M.D or D.O
  • Active unrestricted license to practice medicine
  • Board certification in Internal Medicine or Family Medicine; to include genetics experience
  • Ability to obtain additional licenses as needed
  • Sound understanding of Evidence Based Medicine (EBM)
  • Solid PC skills, specifically using MS Word, Outlook, and Excel
  • Ability to participate in rotational holiday and call coverage

Preferred Qualifications

  • 5+ years of clinical practice experience after completing residency training
  • 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