Medical Director, Inpatient Care Management - TX or FL

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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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

We are currently seeking an Inpatient Care Management Medical Director to join our Optum team. This team is responsible for conducting acute level of care and length of stay reviews for medical necessity for our members being managed within the continuum of care. Our clients include local and national commercial employer, Medicare, and state Medicaid plans. The Medical Directors work with groups of nurses and support staff to manage inpatient care utilization at a hospital, market, regional or national level.

You’ll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Participate in telephonic outreach for collaboration with treating providers. This will include discussion of evidence – based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expenses
• Responsible to collaborate with operational and business partners on clinical and quality initiatives at the site and customer level to address customer expectations
• Is grounded in the use and application of evidence-based medicine (EBM) such as Inter Qual care guidelines and criteria review
• Occasionally, may participate in periodic market oversight meetings with the outward facing Chief Medical Officers, network contractors, nurse management and other internal managers
• Maintain proficiency in all required software and platforms

Although the Optum ICM Medical Director’s work is typically concentrated in a region, they are part of a national organization and team, and collaborate with peers, nurse managers, and non-clinical employees from across the country. In response to customer needs and expectations, Optum is continuously modifying its programs and approaches. Although not a primary job function, Medical Directors with the interest in doing so often can be involved with change design and management.

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.

Required Qualifications:

• MD or DO with an active, unrestricted medical license in Texas or Florida
• Reside in Texas or Florida
• Current Board Certification in Internal Medicine, Family Medicine or Emergency Medicine
• 3+ years of clinical practice experience post residency
• Technical proficiency in computer software and systems
• Private home office and access to high-speed Internet
• Participate in rotational holiday and call coverage

Preferred Qualifications:

• 2+ years of managed care, Quality Management experience and/or administrative leadership experience
• Prior UM experience
• Clinical experience within the past 2 years

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

• Seniority level
  
  Not Applicable

• Employment type
  
  Full-time

• Job function
  
  Health Care Provider
• Industries Hospitals and Health Care

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