Medical Director - Post-Acute Care Management - Care Transitions - Remote

Overview

Optum is a global organization that delivers care aided by technology to help millions live healthier lives. This role supports Care Transitions, focusing on transforming health care and improving health outcomes by coordinating care, resources, and services for enrollees. The team emphasizes inclusion, career development, and a culture that values impact on the communities served.

Why Care Transitions? Our mission is to work with talented people committed to making a positive impact on society by transforming health care. We operate with a forward-thinking approach, leveraging the latest technologies in alignment with the company’s vision and strategy. Remote work is supported from anywhere in the U.S. in daytime hours across continental time zones.

• Provide daily utilization oversight and external communication with network physicians and hospitals.
• Daily utilization management reviews—authorizations and denial reviews.
• Conduct peer-to-peer conversations for clinical case reviews; perform provider telephonic reviews and discussions, sharing tools, information, and guidelines related to cost-effective healthcare delivery and quality of care.
• Communicate effectively with network and non-network providers to ensure successful administration of Care Transitions' services.
• Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers.
• Represent Care Transitions at appropriate external levels, identifying and maintaining relationships with other thought leaders.
• Collaborate with Client Services Team to coordinate approaches to delivery system providers.
• Contribute to the development of action plans and programs to implement strategic initiatives and monitor progress toward goals.
• Interact with network and community physicians, hospital leaders, and other vendors regarding care and services for enrollees.
• Provide leadership to maximize cost management through close coordination with network and provider contracting.
• Meet regularly with Care Transitions leadership to review care coordination issues and develop intervention plans; share ideas about network management issues.
• Provide input on local needs for Analytics Team and Client Services Team to enhance Care Transitions’ products and services.
• Ensure appropriate management of local queries regarding patient case management by responding directly or routing to the appropriate SME.
• Participate on the Medical Advisory Board.
• Provide intermittent, scheduled weekend and evening coverage.
• Perform other duties and responsibilities as required, assigned, or requested.

• Board certification as an MD, DO, or MBBS with a current unrestricted license to practice and willingness to maintain necessary credentials.
• Current, unrestricted medical license and the ability to obtain licensure in multiple states.
• 3+ years of post-residency patient care, preferably in an inpatient or post-acute setting.

• Licensure in multiple states and willingness to obtain additional state licenses with Optum's support.
• Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care.
• Ability to work within a team and manage multiple tasks simultaneously.
• Ability to complete assignments with reasonable oversight, direction, and supervision.
• Strong interpersonal and communication skills (verbal and written) and ability to interact with clinicians, management, and professionals at all levels.
• Proficiency with electronic health records and related technology.
• Highest level of ethics and integrity; flexible and adaptable to a fast-paced environment.

* All employees working remotely will be required to adhere to United Health Group's Telecommuter Policy.

Compensation for this specialty generally ranges from $248,500 - $373,000. Total cash compensation includes base pay and bonus and is based on factors including local labor markets, education, and experience. Benefits include a comprehensive package, incentive and recognition programs, equity stock purchase, and 401k contribution (eligibility requirements apply).…