Market Medical Director - West Valley, UT

    • West Valley City, UT

Position Description

OptumCare is seeking a Market Medical Director to join our Clinical Analysis and Consulting Team in West Valley, UT. You will have the opportunity to drive measureable and meaningful outcomes in the Salt Lake City Market with other members of the team. You will be responsible for improving the quality and efficiency of medical care in the market, and leading the provider network.

Primary Responsibilities:

  • This role will require you to be out in the field with daily travel within the Salt Lake City market, developing and maintain collegial relationships with contracted Providers in efforts to support the business efforts of the organization
  • Provide physician support to Clinical Coverage Review (CCR) operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC)
  • Collaborate with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefits coverage determinations
  • Conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed peer-to-peer
  • Use clinical knowledge in the application and interpretation of UHC medical policy and benefit document language in the process of clinical coverage review for UnitedHealth Care
  • Provide support for CCR nurses and non-clinical staff in multiple sites in a manner conducive to teamwork
  • Communicate and collaborate with network providers in pursuit of accurate and timely benefit determinations for plan participants; educates providers on benefit plans and UHC medical policy
  • Communicate and collaborate with other departments such as the Inpatient Concurrent Review team regarding coverage and other issues
  • Access clinical specialty panel to assist or obtain assistance in complex or difficult cases
  • Document clinical review findings, actions and outcomes in accordance with CCR policies, and regulatory and accreditation requirements
  • Actively participate as a key member of the CCR team in regular meetings and projects focused on communication, feedback, problem solving, process improvement, staff training and evaluation and sharing of program results
  • Provide clinical and strategic leadership when participating on national committees and task forces focused on achieving Clinical Coverage Review goals

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:

  • M.D. or D.O.
  • Active, unrestricted Utah Medical License
  • Current Board Certification in ABMS or AOA specialty
  • 5+ years of clinical practice experience post residency
  • 5+ years hands-on experience in utilization and coverage review in a health plan with commercial and or Medicare Advantage membership
  • Ability to travel within the Salt Lake market the majority of the time

Preferred Qualifications:

  • Strong understanding of and concurrence with evidence-based medicine (EBM) and managed care principles
  • Supervisory skills, including clinical mentoring and coaching expertise
  • Project management background
  • Team player and strong teambuilding skills
  • Creative problem solving skills
  • Excellent presentation skills for both clinical and non-clinical audiences
  • Experience as a practicing physician in value based and/or Global Risk Model

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Market Medical Director, West Valley, UT, Utah

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