- Conduct second level medical necessity/compliance status reviews for all payor types
- Requirement to gain and sustain a working knowledge of the technical systems to perform case reviews
- Meet with case management, utilization management, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status through case reviews
- Interacting with medical staff to discuss medical necessity and concurrent denial cases
- Act as a consultant for the medical staff regarding their decisions for the appropriate medical necessity status of hospitalized patients and supporting documentation
- Participate in the claims denial process by conducting peer to peer discussions with commercial payor medical directors for cases that have been denied concurrently
- Coordinate with Optum/OPAS Subject Matter Expert(s) for questions regarding federal, state and payor and regulatory requirements
- Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application
- Provide focused case by case education on utilization management topics (e.g., documentation) to the medical and UM staff
- Develop and maintain a working knowledge and understanding of OPAS proprietary guidance regarding clinical diagnoses and disease states. Initial and ongoing training will be provided by OPAS
- MD or DO
- Current, unrestricted Medical license in state of residence
- Board certified/eligible
- 3+ years of experience in a hospital-based practice setting
- Demonstrated ability to build rapport with medical staff and hospital leadership
- Ability to collaborate and partner with multiple constituents (administrative, clinical, leadership, etc.)
- Ability to be receptive to feedback and coaching
- Proven solid communication and listening skills
- Demonstrated organizational agility, assumes positive intent, discovers the power pathways and circuits, navigates the organizational maze to get things done
- Proven solid computer skills and working knowledge of EMRs
- Physician Advisor and or Utilization Review experience
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Family Practice Full-Time position in New Orleans, Louisiana - Optum
Description
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives.Primary Responsibilities:
Required Qualifications:
Preferred Qualifications:
California, Colorado, Connecticut, Nevada, New York, Rhode Island, or
Washington Residents Only:
The salary range for California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington residents is $248,582 to $3338,965 per year. Salary range is defined as total cash compensation at target. The actual 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 local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable.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.
Family Practice Full-Time position in New Orleans, Louisiana professionals in New Orleans
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Sabrina Heavey
Law School Student