Medical Director - Pharmacy - Remote

Lensa; Indianapolis (IN); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading career site seeks a Medical Director for Optum, focusing on outpatient pharmacy reviews. This role requires an active physician license and board certification, with responsibilities including clinical reviews, team support, and leadership. The position offers a competitive salary range and comprehensive benefits.

Benefits

Comprehensive benefits packages

Incentives

Stock purchase

401k

Qualifications

• At least 5 years of clinical practice post-residency.
• Participation in weekend and holiday call rotations.
• Strong belief in Evidence-Based Medicine and familiarity with current medical issues.

Responsibilities

• Review and approve pharmacist denials for outpatient medication requests.
• Conduct coverage reviews on medical cases based on member plans.
• Support CCR team members across multiple sites, fostering teamwork.

Skills

Evidence-Based Medicine

Data analysis

Presentation skills

Experience with electronic clinical systems

Education

Active, unrestricted physician license

Board certification in Internal Medicine, Family Practice, or Emergency Medicine

Board certification in Gastroenterology, Rheumatology, Hematology-Oncology

Tools

MS Word

Outlook

Excel

Job description

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Lensa is a leading career site for job seekers at every career stage. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

Optum, a global organization, delivers care aided by technology to help millions live healthier lives. Your work will directly impact health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need. We foster a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Join us to make an impact on communities we serve and help advance health equity globally. Start with Caring. Connecting. Growing together.

Role Overview

The Clinical Coverage Review Medical Director is a key member of the Optum Enterprise Clinical Services Team, primarily focusing on outpatient pharmacy reviews within the Focused Pharmacy Review team. Responsibilities include supporting the Optum Rx Pharmacy Team and Clinical Coverage Review (CCR) operations, which conduct initial clinical reviews of service requests for UnitedHealth Care (UHC). The Medical Director collaborates with leadership to establish, implement, and maintain clinical and operational processes related to outpatient pharmacy and medical coverage determinations, applying clinical knowledge in utilization management activities, particularly pre-service benefit and coverage determinations and communication with physicians and other departments.

Primary Responsibilities

• Review and approve pharmacist denials for outpatient medication requests after reviewing medical records.
• Conduct coverage reviews on medical cases based on member plans and guidelines, render determinations, and communicate with providers.
• Apply and interpret medical and pharmacy policies during clinical reviews.
• Perform daily clinical reviews collaboratively with CCR staff.
• Support CCR team members across multiple sites, fostering teamwork.
• Communicate with providers to ensure accurate benefit determinations and educate on benefit plans and policies.
• Coordinate with other departments and external medical directors on coverage issues.
• Be accessible to CCR staff for inquiries, serve as a clinical resource, and provide coaching and leadership.
• Utilize clinical specialty panels for complex cases.
• Document review findings, actions, and outcomes per policies and regulations.
• Participate in team meetings, process improvements, staff training, and program evaluations.
• Provide clinical and strategic leadership on national committees and task forces.
• Obtain additional state medical licenses as required.
• Participate in rotational weekend and holiday call coverage.
• Perform other duties as assigned by supervisors.

Qualifications

Required

• Active, unrestricted physician license.
• Board certification in Internal Medicine, Family Practice, or Emergency Medicine.
• At least 5 years of clinical practice post-residency.
• Experience with electronic clinical systems.
• Participation in weekend and holiday call rotations.
• Strong belief in Evidence-Based Medicine and familiarity with current medical issues.
• Proficiency in MS Word, Outlook, and Excel.

Preferred

• Board certification in Gastroenterology, Rheumatology, Hematology-Oncology.
• Experience in utilization review and recent clinical practice.
• Data analysis skills and knowledge of managed care industry.
• Reside in PST or MST zones.
• Excellent presentation skills for diverse audiences.

The salary range is $238,000 to $357,500 annually, with benefits including comprehensive packages, incentives, stock purchase, and 401k. The actual compensation depends on experience, location, and other factors. UnitedHealth Group is committed to diversity, equity, and inclusion, and is an equal opportunity employer. Candidates must pass a drug test prior to employment.