Clinical Review Medical Director - Neurology - Remote
location_on2173;2189, Washington Street, Nubian Square, Roxbury, Boston, Suffolk County, Massachusetts, 02119, United States
Job Description
About Optum
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.️ Connecting️ Growing together.
About the Role
Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs.
The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director’s activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre‑service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non‑network physicians, as well as other Enterprise Clinical Services.
The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member’s primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost‑effective quality medical care is provided to members.
You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Compensation and Benefits
Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far‑reaching choice of benefits and incentives.
Equal Opportunity and Workplace Policy
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Work location
Work model: Remote
2173;2189, Washington Street, Nubian Square, Roxbury, Boston, Suffolk County, Massachusetts, 02119, United States
Boston, Massachusetts
Key Responsibilities
- check_circleConduct coverage reviews based on member plan benefits and proprietary policies
- check_circleRender coverage determinations and document clinical review findings
- check_circleInterpret benefit language and policies for clinical coverage reviews
- check_circleParticipate in daily clinical rounds as requested
- check_circleCollaborate with internal partners
- check_circleCollaborate with network and non-network providers for benefit determinations
- check_circleEngage in peer-to-peer discussions with requesting providers
- check_circleEducate providers on benefit plans and medical policy
Requirements
- verifiedM.D or D.O.
- verifiedActive unrestricted license to practice medicine
- verifiedBoard Certification in Neurology through ABMS or AOA
- verified5+ years clinical practice after residency
- verifiedSound understanding of Evidence Based Medicine
- verifiedMS Word, Outlook, and Excel