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

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.

At Care Transitions, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. Care Transitions is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions. We do health care differently and we are changing health care one patient at a time.

Moreover, have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company's technical vision and strategy.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. We are currently looking for Medical Directors that can work daytime in any of the continental time zones in the US.

• Provide daily utilization oversight and external communication with network physicians and hospitals
• Daily UM reviews - authorizations and denial reviews
• Conduct peer to peer conversations for the clinical case reviews, as needed
• Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
• Communicate effectively with network and non-network providers to ensure the successful administering of Care Transitions' services
• Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
• Represent Care Transitions on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders
• Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers
• Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
• Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees
• Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting
• Regularly meet with Care Transitions' leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues
• Provide input on local needs for Analytics Team and Client Services Team to better enhance Care Transitions' products and services
• Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME
• Participate on the Medical Advisory Board
• Providing intermittent, scheduled weekend and evening coverage
• Perform other duties and responsibilities as required, assigned, or requested

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.

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

• Licensure in multiple states
• Willing to obtain additional state…