Medical Director - Post-Acute Care Internal Medicine - Remote in US

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Medical Director will partner with cross-functional teams and senior leaders to ensure that Optum leads the industry in innovative health management strategies and is considered an expert in the field of post-acute care. The role as a physician leader, has a proven track record of innovation, achievement of measurable goals, and exceptional clinical competencies. They take a proactive approach to the marketplace and are responsible for continuously reshaping Optum’s corporate wide strategies.

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

Primary Responsibilities:

• Provide daily utilization oversight and external communication with network physicians and hospitals
• Daily UM reviews - authorization and denial reviews
• Conduct peer to peer conversations for clinical case reviews as needed
• Conduct provider telephonic review and discussion, share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
• Communicate effectively with providers to ensure the successful administering of Optum’s services
• Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
• Collaborate with Team to ensure a coordinated approach toward our member’s health care
• The development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
• Provide leadership and guidance to maximize cost management through close coordination with network and provider contracting
• Regularly meet with Optum’s 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 Care Management Team to better enhance Optum’s 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
• 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.

Required Qualifications:

• Graduate of a recognized accredited medical school
• Current, unrestricted medical license and residency in the United States
• Board certified in a recognized ABMS specialty
• Board Certified in Internal Medicine
• 3+ years of experience practicing in an acute inpatient environment, where dealing with managed care organizations made up at least half of inpatient practice
• Proven understanding of population-based medicine with preference given to significant experience with the Medicare, Medicaid, and Commercial populations
• Proficient computer skills
• Proven working knowled