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    • Medical Director - South Boston - Optum

    Optum
    Optum South Boston

    1 week ago

    Optum background
    Description

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives.

    The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.

    Care Transitions is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions.

    We do healthcare differently and we are changing healthcare one patient at a time.

    You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

    Primary Responsibilities:

    • Provide daily utilization oversight and external communication with network physicians and hospitals
    • Daily UM reviews - authorizations and denial reviews
    • Conduct peer to peer conversations for the clinical case reviews, as needed
    • Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
    • Communicate effectively with network and non-network providers to ensure the successful administering of Care Transitions' services
    • Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
    • Represent Care Transitions on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders
    • Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers
    • Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
    • Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees
    • Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting
    • Regularly meet with Care Transitions' leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues
    • Provide input on local needs for Analytics Team and Client Services Team to better enhance Care Transitions' products and services
    • Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME
    • Participate on the Medical Advisory Board
    • Providing intermittent, scheduled weekend and evening coverage
    • Perform other duties and responsibilities as required, assigned, or requested

    Required Qualifications:

    • Board certification as an MD, DO, MBBS with a current unrestricted license to practice and willing to maintain necessary credentials to retain the position
    • Current, unrestricted medical license and the ability to obtain licensure in multiple states
    • 3+ years of post-residency patient care, preferably in inpatient or post-acute setting

    Preferred Qualifications:

    • Licensure in multiple states
    • Willing to obtain additional state licenses, with Optum's support
    • Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care
    • Demonstrated ability to work within a team environment while completing multiple tasks simultaneously
    • Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision
    • Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non-medical professionals
    • Demonstrated competence in use of electronic health records as well as associated technology and applications
    • Proven excellent organizational, analytical, verbal and written communication skills
    • Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues
    • Proven highest level of ethics and integrity
    • Proven highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment
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