Utilization Management Medical Director, Genetics - Remote
Optum
Edina, MN
16 days ago
$238,000 - $357,500
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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