Remote Medical Director, Surgical Specialty

Optum; Atlanta (GA); A distancia; USD 249.000 - 373.000; Jornada completa

Descripción de la vacante

Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service benefit coverage determinations and medical necessity reviews. You will collaborate with leadership and staff to implement clinical and operational processes for cost-effective care.

You’ll work with network and non-network physicians and participate in clinical rounds, with remote work available across the U.S.

Formación

• MD or DO required and licensed to practice medicine.
• Board certification in a surgical specialty (ABMS/AOA).
• Active unrestricted medical license with ability to obtain more licenses.
• 5+ years clinical practice after residency.
• Solid understanding of Evidence Based Medicine (EBM).
• Strong MS Word, Outlook and Excel skills.
• Ability to participate in rotational holiday and call coverage.

Responsabilidades

• Conduct coverage reviews based on member plan benefits and policies, render determinations.
• Document findings and outcomes per policies and regulatory requirements.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies during clinical reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers to pursue timely determinations.
• Coordinate with internal partners and participate in holiday/call coverage.

Conocimientos

Clinical leadership

Evidence Based Medicine

Regulatory compliance

Educación

MD/DO

Board certification in surgical specialty (ABMS or AOA)

Herramientas

MS Word

Outlook

Excel

Descripción del empleo

Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service benefit coverage determinations and medical necessity reviews. You will collaborate with leadership and staff to implement clinical and operational processes for cost-effective care.

You’ll work with network and non-network physicians and participate in clinical rounds, with remote work available across the U.S.