Regional Medical Director, NAMM Optum - Ontario, CA (Physician #)
Posted on: February 20, 2021
We at NAMM, a part of OptumCare, deliver a clearly
differentiated level of outcome and service adherence. Come join
our team and add to our bench strength as we execute on managed
care 2.0 bringing together revenue optimization, appropriate
utilization, unit cost management and strategic acquisitions.
Quality care saves money without exception. Careers at OptumCare.
We're on a mission to change the face of health care. As the
largest health and wellness business in the US, we help 58 million
people navigate the health care system, finance their health care
needs and achieve their health and well-being goals. Fortunately,
we have a team of the best and brightest minds on the planet to
make it happen. The Medical Director interacts with Physicians and
IPA staff to ensure that patient needs are met in an efficient and
medically appropriate manner. The Medical Director of is
responsible for the Medical Management functions that include
vendor relations, Utilization Management and business development.
In addition, this role provides prime management, oversight and
development for major program and functional areas within Medical
Management. These include medical policy, patient centered medical
home, Medicaid, Health and Wellness, population management, and
reporting capabilities. The Medical Director is also responsible
for working with physicians and other providers, especially PCMH
practices, to improve the quality and efficiency of care in the
network and integrate these providers into clinical initiatives.
- Works primarily with the physician community around issues of
particular patients, balancing business and clinical concerns.
- Provides limited utilization management for outpatient medical,
surgical and pharmacy activity.
- Participates in medical appeals activity. Reviews all 2nd-level
overturned cases related to medical necessity/investigational
issues in the context of potential medical policy updates.
- Works with the Appeals area on appeals related to utilization
- Provides medical leadership and physician advice to the quality
management area with respect to quality improvement studies,
quality improvement committees, primary care assessments (both
office-site assessments and medical record document reviews).
- Performs peer reviews on quality complaints, sentinel events,
and quality-of-care referrals.
- Serves as Physician Advisor for other areas within the company,
including but not limited to Sales and Marketing, Underwriting,
PHP, and Provider Services.
- Provides medical leadership and advice for conformance with
standards and guidelines for NCQA, URAC, state and federal
regulators, and other accrediting bodies.
- Acts as liaison for communication with physicians, hospitals,
and other providers in the community.
- Reviews customer service and claims inquiries.
- Possess a current and unrestricted MD or DO license in
- 3 or more years of experience working as a Medical Director in
a managed care setting
- 3 or more years of experience in utilization management,
utilization review and prior authorization
- 3 or more years of experience interacting with both group and
- Experience with inpatient/hospitalist management
- Experience with and comfort level in supervising Advanced
- Board certification in their chosen specialty
- If you need to enter a work site for any reason, you will be
required to screen for symptoms using the ProtectWell mobile app,
Interactive Voice Response (i.e., entering your symptoms via phone
system) or similar UnitedHealth Group-approved symptom screener.
When in a UnitedHealth Group building, employees are required to
wear a mask in common areas. In addition, employees must comply
with any state and local masking orders Preferred Qualifications:
- Prior experience working with clinical information technology
- Public presentation skills What's the first thing that happens
when one of the most successful groups in Riverside County comes
together with a global leader in health care? Opportunity. With
NAMM joining OptumCare and the UnitedHealth Group family of
companies, people like you will find increasing levels of
challenge, impact and professional success. With a vibrant network
of hospitals and urgent care centers, we're changing health care
for the better by improving access to affordable, high quality
care, and working together to improve the patient experience. That
takes passion, commitment, intense focus and the ability to
contribute effectively in a highly collaborative team environment.
Are you with us? Learn more about this exciting opportunity to do
your life's best work.(sm)
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. Job
Keywords: Medical Director, MD, DO, managed care, UM, Utilization
Management, CM, Case Management, IPA, clinical informatics,
Ontario, Riverside, San Bernardino, San Diego, CA, Telecommute
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Keywords: Optum, Ontario , Regional Medical Director, NAMM Optum - Ontario, CA (Physician #), Executive , Ontario, California
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