Clinical Assessment Review Expert Sr Medical Director - Remote

At United Healthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together
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You’ll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.

• Together with the clinical RN team, evaluate clinical program effectiveness, including technology enhancements by performing utilization management clinical chart reviews to ensure consistency and accuracy of clinical decisions
• Make recommendations to optimize clinical programs to UCS Medical Management leadership based on current and future end-to-end process and criteria
• Provide LOB Chief Medical Officers with timely clinical consistency data to aid in network negotiations and monitor responses to provider and market feedback
• Appropriately represent historical trends, gaps, deficiencies, and risks
• Serve as a subject matter expert on the appropriate application of nationally recognized clinical guidelines and criteria
• Identify root cause and solution development including documenting recommendations for change using data to effect positive change in utilization patterns
• Work with finance and functional partners on comprehensive operating reviews, including ROI and SG&A oversight
• Responsible for continuous process feedback to Optum clinical program operational leaders based on findings

• Perform clinical chart reviews to evaluate the impact of clinical programs, medical policies, processes, and to investigate utilization management trends, identified by health care economics (HCE) or as requested by senior leadership, to determine root causes
• Provide guidance and clinical expertise to inform process and performance improvement
• Serve as a key resource and provide explanation and information about chart review findings to others, including complex/critical issues
• Identify and communicate opportunities to optimize policies, processes, performance, and promote automation to leaders and impacted stakeholders
• Attend meetings with key stakeholders as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• MD or DO with an active, unrestricted medical license
• Current Board Certification and maintenance in an ABMS or AOBMS specialty
• 5+ years clinical practice experience, including direct P&L responsibilities
• 5+ years of Utilization Management experience with demonstrated leadership role in provider or plan-based setting
• Familiar with URAC and NCQA UM requirements
• Inter Qual Certified Expert Resource or achieves within 6 months of accepting role
• Proven ability to be self-motivated and independently problem solve, applying critical thinking strategies
• Advanced proficiency in Microsoft applications
• Designated workspace and access to install secure high-speed internet via cable/DSL in home
• Travel may be required less than 10% of the time

• MBA, MMM, or MPH
• Experience presenting complex information to senior leaders
• Prior Lead UM / CMIO / CMO role
• Experience with clinical criteria and/or Medical Policy
• Extremely detail oriented with focus on quality/quality assurance

• Demonstrate strategic flexibility under change and uncertainty
• Encourage idea sharing and recognize novel approaches to organizational problems
• Work in an ever-changing, fast-paced

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

Compensation for this specialty generally ranges from $200,000 to $350,000. 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…