Medical Director - Vascular - Endovascular Surgery - Telecommute
Company: UnitedHealth Group
Location: Indianapolis
Posted on: May 16, 2022
Job Description:
Combine two of the fastest-growing fields on the planet with a
culture of performance, collaboration and opportunity and this is
what you get. Leading edge technology in an industry that is
improving the lives of millions. Here, innovation is not about
another gadget; it is about making health care data available
wherever and whenever people need it, safely and reliably. There is
no room for error. If you are looking for a better place to use
your passion and your desire to drive change, this is the place to
be. It's an opportunity to do your life's best work.(sm)As part of
the Focus Claims Review team at Optum, the Medical Director
provides leadership, organization, and direction for the claims
review program. They are responsible for the overall quality,
effectiveness and coordination of the medical services provided
through Optum. The Medical Director will participate in all aspects
of claim review services including provider telephonic discussions
and provider appeals. -In addition, the Medical Director may also
be asked to assist in the direction and oversight in the
development and implementation of policies and procedures and
clinical criteria for all medical programs and services. -The
Medical Director will serve as a liaison between Optum, physicians,
and other medical service providers in selected situations
primarily related to medical claim reviews. -You'll enjoy the
flexibility to telecommute* from anywhere within the U.S. as you
take on some tough challengesPrimary Responsibilities:
- Reviews surgical and other professional claims for correct
coding using clinical record -
- Participation in Training regarding URAC, NCQA, Regulatory
Compliance, Confidentiality, Conflict of Interest, HIPAA, and
department specific training as applicable -
- Discusses cases and clinical coding situations with treating
providers telephonically during scheduled hours -
- Participates in periodic clinical conferences / calls and in
ongoing internal performance consistency reviews -
- Composes, if needed, patient situation specific, clinical
summaries and rationales for medical necessity decisions -
- Is available for occasional, periodic weekend and holiday as
needed telephonic and remote computer expedited clinical decisions
-
- Supports compliance with regulatory agency standards and
requirements (e.g., CMS, NCQA, URAC, state / federal and
third-party payers) -
- Ability to travel to scheduled company meetings and activities
in US -
- Ability to assist in marketing presentations to clients and
ongoing relationship management activities with existing clients if
requested to do so
- Provide Clinical support for staff that conduct initial
reviews
- Good understanding of professional performance measurement and
related possible discussions/interventions with selected
providers/groups/organizations -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:
- MD or DO
- Current, active and fully unrestricted medical license -
- Current board certification in Vascular Surgery
- 5+ years of clinical experience in Endovascular/Vascular
Surgery post residency - -
- MS Office (MS Word, Excel, and Power Point) -Preferred
Qualifications:
- Current, ABVM Certification -
- Experience in managed care -
- Experience with professional claim coding / claim coding
reviews -
- Experience with integration of clinical and financial data,
development of utilization and performance reporting tools, and
communication of performance data to physicians and other health
care providers -
- Knowledge of claim coding resources and techniques
- Proficient computer skills and ability to learn to use clinical
and claims software -
- Excellent interpersonal skills and the ability to work over the
telephone with other colleagues including physicians, nurses, PTs,
OTs and other similar personnelTo protect the health and safety of
our workforce, patients and communities we serve, UnitedHealth
Group and its affiliate companies require all employees to disclose
COVID-19 vaccination status prior to beginning employment. In
addition, some roles and locations require full COVID-19
vaccination, including boosters, as an essential job function.
UnitedHealth Group adheres to all federal, state and local COVID-19
vaccination regulations as well as all client COVID-19 vaccination
requirements and will obtain the necessary information from
candidates prior to employment to ensure compliance. Candidates
must be able to perform all essential job functions with or without
reasonable accommodation. Failure to meet the vaccination
requirement may result in rescission of an employment offer or
termination of employment.Careers with Optum. Here's the idea. We
built an entire organization around one giant objective; make
health care work better for everyone. So when it comes to how we
use the world's large accumulation of health-related information,
or guide health and lifestyle choices or manage pharmacy benefits
for millions, our first goal is to leap beyond the status quo and
uncover new ways to serve. Optum, part of the UnitedHealth Group
family of businesses, brings together some of the greatest minds
and most advanced ideas on where health care has to go in order to
reach its fullest potential. For you, that means working on high
performance teams against sophisticated challenges that matter.
Optum, incredible ideas in one incredible company and a singular
opportunity to do your life's best work.(sm)Colorado, Connecticut
or Nevada Residents Only: The salary range for Colorado residents
is $254,600 to $295,200. The salary range for Connecticut / Nevada
residents is $254,600 to $295,200. The range and pay mix of base
and bonus is variable based upon experience and metric achievement.
Pay is based on several factors including but not limited to
education, work experience, certifications, etc. In addition to
your salary, UnitedHealth Group offers benefits such as, a
comprehensive benefits package, incentive and recognition programs,
equity stock purchase and 401k contribution (all benefits are
subject to eligibility requirements). No matter where or when you
begin a career with UnitedHealth Group, you'll find a far-reaching
choice of benefits and incentives.*All Telecommuters will be
required to adhere to UnitedHealth Group's Telecommuter
Policy.Diversity creates a healthier atmosphere: UnitedHealth Group
is an Equal Employment Opportunity/Affirmative Action employer 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.UnitedHealth Group is
a drug-free workplace. Candidates are required to pass a drug test
before beginning employment.
Keywords: UnitedHealth Group, Indianapolis , Medical Director - Vascular - Endovascular Surgery - Telecommute, Executive , Indianapolis, Indiana
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