Clinical Assessment Review Expert Sr Medical Director - Remote

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

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

Primary Responsibilities:

• Together with the clinical RN team, evaluate clinical program effectiveness, including technology enhancements by performing utilization management clinical chart reviews to ensure consistency and accuracy of clinical decisions
• Make recommendations to optimize clinical programs to UCS Medical Management leadership based on current and future end-to-end process and criteria
• Provide LOB Chief Medical Officers with timely clinical consistency data to aid in network negotiations and monitor responses to provider and market feedback
• Appropriately represent historical trends, gaps, deficiencies, and risks
• Serve as a subject matter expert on the appropriate application of nationally recognized clinical guidelines and criteria
• Identify root cause and solution development including documenting recommendations for change using data to effect positive change in utilization patterns
• Work with finance and functional partners on comprehensive operating reviews, including ROI and SG&A oversight
• Responsible for continuous process feedback to Optum clinical program operational leaders based on findings

Associate Clinical Assessment & Review Expert:

• Perform clinical chart reviews to evaluate the impact of clinical programs, medical policies, processes, and to investigate utilization management trends, identified by health care economics (HCE) or as requested by senior leadership, to determine root causes
• Provide guidance and clinical expertise to inform process and performance improvement
• Serve as a key resource and provide explanation and information about chart review findings to others, including complex/critical issues
• Identify and communicate opportunities to optimize policies, processes, performance, and promote automation to leaders and impacted stakeholders
• Attend meetings with key stakeholders as assigned

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 with an active, unrestricted medical license
• Current Board Certification and maintenance in an ABMS or AOBMS specialty
• 5+ years clinical practice experience, including direct P&L responsibilities
• 5+ years of Utilization Management experience with demonstrated leadership role in provider or plan-based setting
• Familiar with URAC and NCQA UM requirements
• InterQual Certified Expert Resource or achieves within 6 months of accepting role
• Proven ability to be self-motivated and independently problem solve, applying critical thinking strategies
• Advanced proficiency in Microsoft applications
• Designated workspace and access to install secure high-speed internet via cable/DSL in home

• Travel may be required less than 10% of the time

Preferred Qualifications:

• MBA, MMM, or MPH
• Experience presenting complex information to senior leaders
• Prior Lead UM / CMIO / CMO role
• Experience with clinical criteria and/or Medical Policy
• Extremely detail oriented with focus on quality/quality assurance

Skills You Will Develop:

• Demonstrate strategic flexibility under change and uncertainty
• Encourage idea sharing and recognize novel approaches to organizational problems
• Work in an ever changing, fast-paced

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Compensation for this specialty generally ranges from $200,000 to $350,000. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer 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 us, 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.