- Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
- Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements
- Engage with requesting providers as needed in peer-to-peer discussions
- Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
- Participate in daily clinical rounds as requested
- Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
- Communicate and collaborate with other internal partners
- Call coverage rotation
- M.D or D.O
- Board certification in an ABMS specialty
- Active unrestricted license to practice medicine
- 5+ years of clinical practice experience after completing residency training
- Sound understanding of Evidence Based Medicine (EBM)
- Solid PC skills, specifically using MS Word, Outlook, and Excel
- State licensures in AZ, AR, MN, TX
- Board certification in either Internal Medicine, Family Medicine, or PM&R
- Experience in utilization and clinical coverage review for DME
- Proven excellent oral, written, and interpersonal communication skills, facilitation skills
- Proven data analysis and interpretation aptitude
- Proven innovative problem-solving skills
- Proven excellent presentation skills for both clinical and non-clinical audiences
-
Medical Director
1 week ago
NVA Saint Petersburg, United States**The Central Animal Hospital in St. Pete is seeking an ambitious Managing veterinarian to join our Team** · Central Animal was established in the late 1970s and has been serving the St. Petersburg and greater Tampa Bay community for more than 40 years. We offer unique services i ...
-
Medical Director
1 week ago
ACI Federal Petersburg, United States Part timeTitle Medical Director · EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other ...
-
Medical Director
1 week ago
National Veterinary Associates Petersburg, United StatesJob Description · Job DescriptionThe Central Animal Hospital in St. Pete is seeking an ambitious Managing veterinarian to join our Team · Central Animal was established in the late 1970s and has been serving the St. Petersburg and greater Tampa Bay community for more than 40 yea ...
-
Medical Director
4 days ago
National Veterinary Associates Petersburg, United StatesJob Description · The Central Animal Hospital in St. Pete is seeking an ambitious Managing veterinarian to join our Team · Central Animal was established in the late 1970s and has been serving the St. Petersburg and greater Tampa Bay community for more than 40 years. We offer un ...
-
Medical Director Physician
2 weeks ago
DocCafe , FL, United StatesDocCafe has an immediate opening for the following position: Physician - Medical Director in Florida. · DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career. · Register now to apply for this job and for access to 120,000+ oth ...
-
Medical Director
2 days ago
Direct Jobs St Petersburg, United StatesThe Central Animal Hospital in St. Pete is seeking an ambitious Medical Director to join our Team · Central Animal was established in the late 1970s and has served the St. Petersburg and greater Tampa Bay community for over 40 years. We offer unique services in-house including We ...
-
Medical Director
2 weeks ago
UnitedHealth Group St Petersburg, United StatesOptum 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 ...
-
Envision Physician Services St Petersburg, United StatesEnvision Physician Services is seeking a Full-Time · Emergency Medicine Medical Director · to become part of our prestigious Practice at HCA Florida St. Petersburg Hospital, located in St. Petersburg, Florida. · ED Features: · 215-Bed Hospital · 26 Bed ED with additional 8-bed ...
-
Office of Medical Education Director
3 weeks ago
Johns Hopkins Health System St. Petersburg, United StatesJob Summary · Establishes and remains accountable for overall operational administration of the Office of Medical Education. The OME Director will work in partnership with the Director of Medical Education/DIO (physician) to foster teamwork, strategic growth opportunities, operat ...
-
Office of Medical Education Director
3 weeks ago
Johns Hopkins Medicine St Petersburg, United StatesShare This Page · Job Details · Requisition #: · 636091 · Location: · Johns Hopkins All Children's Hospital, · St. Petersburg, · FL 33701 · Category: · Leadership · Schedule: · Day Shift · Job Summary · Establishes and remains accountable for overall operational administ ...
-
Program Medical Director, Critical Care
2 weeks ago
Sound Physicians Petersburg, United States Full timeTo our prospective teammates, · I am the Regional Medical Director of Sound Critical Care in the greater Richmond area for our growing group of hospital partners. I am proud to lead our team as we expand our partnership with Bon Secours to include Southside Regional Medical Cente ...
-
Envision Physician Services Saint Petersburg, FL, United StatesEnvision Physician Services is seeking a Full-Time Emergency Medicine Medical Director to become part of our prestigious Practice at HCA Florida St. Petersburg Hospital, located in St. Petersburg, Florida. · ED Features: · ~215-Bed Hospital · ~26 Bed ED with additional 8-bed F ...
-
HCA Physician Recruitment Saint Petersburg, FL, United StatesHCA has immediate opening for BE/BC Anesthesiologists to serve as Facility Medical Director at St. Petersburg General Hospital. This is an excellent opportunity for an experienced physician to move into a leadership role. Practice: · Call expectations: 1 weekday per week and 1 w ...
-
Don / Director of Nursing
3 weeks ago
Pristine Healthcare Saint Petersburg, United StatesThe Director of Nursing is responsible for administration of nursing service in the Center. He/she directs, plans, and coordinates service activities of professional Nursing and auxiliary Nursing personnel in rendering customer care. The Director of Nursing interprets Center poli ...
-
Program Director
2 weeks ago
Ultimate Medical Academy Clearwater, United StatesJob Posting: · **Summary of Position**: · The Dental Program Director (PD) is responsible for the overall effectiveness of the Dental program, as well as overseeing the management of the core courses at the Clearwater campus, and directly supervises the faculty who report to them ...
-
Portfolio Community Manager
2 weeks ago
Associa Saint Petersburg, United StatesAssocia is currently looking for a Community Association Manager (CAM) to join our team in St. Petersburg, FL. As a Community Association Manager, you will work closely with our clients and vendors, and partner with other Associa departments. To be successful in this role you wil ...
-
Recruiter
2 weeks ago
Princeton Consumer Research Saint Petersburg, United StatesThe Recruiter is responsible for the recruitment of potential study participants for studies conducted at Princeton Consumer Research Inc. and as receptionist, is the first point of contact for people (clients/panelists) contacting Princeton Consumer Research, Inc. · Upon occasio ...
-
Medical Records Specialist
2 weeks ago
HCA Florida Northside Hospital Saint Petersburg, United States**Introduction**: · Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family Jump-start your career as a(an) Medical Records Specialist today with HCA Florida Northside Hospital. · ...
-
Academic Clinical Support Liaison
3 weeks ago
Galen College of Nursing Saint Petersburg, United StatesThis position is incentive eligible. · **Introduction**: · Are you passionate about delivering superior work outcomes? At Galen College of Nursing, we are committed to a single purpose: offering excellence in nursing education. Our staff and administration live out our vision We ...
-
Athletic Trainer Associate
3 weeks ago
Philadelphia Phillies Baseball Operations Department Clearwater, United States**Job Title**:Athletic Trainer Associate · **Department**:Player Development · **Status**:Full-Time, Temporary/Seasonal · **Description**: · Associates will have the opportunity to learn in a fast-paced environment by participating in staff continuing education and formation of i ...
Medical Director - St. Petersburg, United States - UnitedHealth Group
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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs.
The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services.
The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member's primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost-effective quality medical care is provided to members.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
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:
Preferred Qualifications:
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $, to $, annually. 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 k 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.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
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.
