Medical Director Otolaryngology - Remote PST or MST

Medical Director Otolaryngology - Remote PST or MST

06 Sep 2024
Washington, Tacoma, 98401 Tacoma USA

Medical Director Otolaryngology - Remote PST or MST

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:

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

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:

M.D or D.O.

Board certification in Otolaryngology (ENT)

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

Participate in call coverage rotation

Preferred Qualifications:

Reside in either MST or PST zone

Experience in utilization and clinical coverage review

Excellent oral, written, and interpersonal communication skills, facilitation skills

Data analysis and interpretation aptitude

Innovative problem-solving skills

Excellent presentation skills for both clinical and non-clinical audiences

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, Washington, Washington, D.C. Residents Only: The salary range for this role is $286,104 to $397,743 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 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.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.

Related jobs

  • Overview

  • Overview

  • Overview

  • America\'s Best is part of National Vision, one of the largest optical retailers in the United States. The America’s Best brand continues to grow, with 1000 stores and counting. Each location combines both parts of the optical equation – eyewear and eye care – into one excellent experience at a single low price.

  • The MLS performs pre-analytic, analytic, and post analytic phases of laboratory testing procedures from waived to moderate and high complexity testing. The MLS recognizes appropriate and inappropriate selection of lab tests and correlates lab results to patients clinical condition. S/he possess scientific knowledge to evaluate quality control, instrument, and result data. Other duties include: responsibility for documentation of all activities, monitoring supplies; compliance with all regulatory and accreditation requirements related to safety and laboratory testing; face to face and telephone customer service; computer data entry and retrieval; workplace cleanliness and maintenance. May oversee QA activities, method evaluation, teaching, point-of-care testing, and new procedure implementation. May research new methods.

  • Overview Find Your Passion and Purpose as a Territory Operations Director Home Health RN Registered Nurse Reimagine Your Career in Corporate Healthcare As a professional, you know that what you do impacts you as much as our patients and their families, and at AccentCare, we are united in our relentless drive to reimagine care because we want to provide the service we would seek for our own families. We think it’s really special to be a part of our patient’s health journey and create incredible memories while providing world-class patient care. Offer Based on Years of Experience Will be covering Linwood, Tacoma and Redding Areas RN License Required Strong Home Health Management Experience Salary: $145-$175K + Bonus What You Need to Know Our Investment in You We are committed to offering comprehensive benefits and rewards to full-time employees who work over 30 hours per week and their families, including: Medical, dental, and vision coverage Paid time off and paid holidays Professional development Company-matching 401(k) Flexible spending and health savings accounts Company store credit for your first AccentCare-branded scrubs for patient-facing employees Qualifications Be the Best Territory Operations Director Home Health RN Registered Nurse You Can Be If you meet these qualifications, we want to meet you! Bachelor\'s Degree in a related field, or equivalent education and experience. Ability to become and maintain Hospice and Palliative Care Administrator (CHPCA) certification within 12 months from date of hire. Previous executive management experience preferred. Ability to conduct overnight and frequent travel. Familiar with Electronic Medical Record (EMR) systems. Knowledgeable about the Hospice Medicare regulations and Joint Commission standards. Familiarity with state hospice regulations for those states Director, Executive Operations (DEO) will be advising Come As You Are At AccentCare, our care is most compassionate when we empathize and engage with everyone, and we are at our best when we value diverse perspectives, foster open dialogue, and enact change. And we are stronger when each of us is empowered to grow, be our unique selves, and feel a sense of inclusion and belonging. AccentCare is proud of how we are building a culture and inclusive infrastructure to help elevate the voice of all our employees with a special focus on the underrepresented and marginalized. We offer equal employment opportunities regardless of a person’s race, ethnicity, sex, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental disability, physical disability, or any other protected classification.

  • Come join an awesome team as the Community Sales Director!

Job Details

Jocancy Online Job Portal by jobSearchi.