Talent.com
Clinical Review Medical Director - Cardiology or Neurology - Remote
Clinical Review Medical Director - Cardiology or Neurology - RemoteUnitedHealth Group • San Diego, CA, United States
No longer accepting applications
Clinical Review Medical Director - Cardiology or Neurology - Remote

Clinical Review Medical Director - Cardiology or Neurology - Remote

UnitedHealth Group • San Diego, CA, United States
30+ days ago
Job type
  • Full-time
  • Remote
Job 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 :
  • 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.
  • Active unrestricted license to practice medicine
  • Board Certification in Cardiology or Neurology
  • 5+ years of clinical practice experience after completing residency training
  • Sound understanding of Evidence Based Medicine (EBM)
  • Proven solid PC skills, specifically using MS Word, Outlook, and Excel
  • Preferred Qualifications :
  • Experience in utilization and clinical coverage review
  • Proven data analysis and interpretation aptitude
  • Proven innovative problem-solving skills
  • Demonstrated excellent presentation skills for both clinical and non-clinical audiences
  • Demonstrated excellent oral, written, and interpersonal communication skills, facilitation skills
  • Current licensure in New Mexico, Arizona or Indiana
  • Willing to obtain additional licensures if needed
  • All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
  • Compensation for this specialty generally ranges from $238,000 to $357,500. 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._

    Create a job alert for this search

    Medical Director • San Diego, CA, United States

    Related jobs
    Director, Oncology Imaging - (Remote)

    Director, Oncology Imaging - (Remote)

    Eisai • San Diego, CA, United States
    Remote
    Full-time
    At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai's human health care (hhc) mission.We're a growing pharm...Show more
    Last updated: 30+ days ago • Promoted
    Director, Medical Director

    Director, Medical Director

    Pfizer • San Diego, CA, US
    Permanent
    This position is for a Medical Director within the CDK4 program.This individual contributor position will be responsible for supporting clinical trial(s). The successful candidate should ideally hav...Show more
    Last updated: 3 days ago • Promoted
    Late Stage Oncology Clinical Scientist (Director, Non MD) Multiple Positions

    Late Stage Oncology Clinical Scientist (Director, Non MD) Multiple Positions

    Pfizer • San Diego, California, United States
    Permanent
    You will be responsible for scientific oversight, data integrity and quality of clinical trial(s) in support of the development strategy for programs within our Late-Stage Oncology portfolio.Clinic...Show more
    Last updated: 23 hours ago • Promoted
    Medical Director Physician

    Medical Director Physician

    Vivo HealthStaff • San Diego, CA, US
    Full-time
    Vivo HealthStaff is searching for an Internal Medicine or Family Practice Physician with a desire to work with the geriatric population. The physician will be the clinical leader of an expansion in ...Show more
    Last updated: 30+ days ago • Promoted
    Senior Medical Director

    Senior Medical Director

    Kumquat Biosciences Inc. • San Diego, CA, United States
    Full-time
    At Kumquat, we strive to develop life changing medicines in an efficient and innovative way with the shared mission of patient focus. The Medical Director plays an essential role in leading the deve...Show more
    Last updated: 23 days ago • Promoted
    Associate or Full Professor (HS Clin, Clin X) Medical Director of Pediatric Heart Failure and Cardiac Transplantation

    Associate or Full Professor (HS Clin, Clin X) Medical Director of Pediatric Heart Failure and Cardiac Transplantation

    UC San Diego • San Diego, CA, United States
    Full-time
    Medical Director of Pediatric Heart Failure and Cardiac Transplantation .The posted UC Salary scales set the minimum pay at the appointment as determined by appointment type and, if applicable, r...Show more
    Last updated: 30+ days ago • Promoted
    Director Of Clinical Management Neuro Rehab

    Director Of Clinical Management Neuro Rehab

    BrightSpring Health Services • San Diego, California, USA
    Full-time
    Rehab Without Walls Neuro Rehabilitation.Serving as a driving force in the recovery process our therapy team executes customized treatment plans that deliver real results and exceed patients expect...Show more
    Last updated: 12 days ago • Promoted
    Physician / Neurology / California / Permanent / Associate Medical Director - Neurology - 100% Remot

    Physician / Neurology / California / Permanent / Associate Medical Director - Neurology - 100% Remot

    eviCore healthcare • San Diego, CA, US
    Part-time
    Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United Sta...Show more
    Last updated: 30+ days ago • Promoted
    Director, Maternal-Fetal Medicine Division — Clinical Leader

    Director, Maternal-Fetal Medicine Division — Clinical Leader

    Health eCareers • San Diego, California, United States
    Full-time
    A leading healthcare institution in San Diego is seeking a Director for the Division of Maternal-Fetal Medicine.The role requires an experienced physician with a strong clinical background in Mater...Show more
    Last updated: 6 days ago • Promoted
    Director, Clinical Pharmacy

    Director, Clinical Pharmacy

    CareMore Health • San Diego, CA, US
    Full-time
    CareMore Health is a physician-founded and physician-led organization that has been transforming care delivery since 1992. With 25 clinics, 65,000+ members and partnerships with 30+ health plans, we...Show more
    Last updated: 14 days ago • Promoted
    Medical Director

    Medical Director

    Metric Bio • San Diego, CA, US
    Full-time
    Metric Bio is representing a client who are a start-up within the clinical research organization space, to help them find a. Medical Director to lead phase I-III clinical services,.This is a great o...Show more
    Last updated: 6 days ago • Promoted
    Director, Neuropsychiatry Clinical Translational Biomarker Lead

    Director, Neuropsychiatry Clinical Translational Biomarker Lead

    Johnson & Johnson • San Diego, California, USA
    Full-time
    At Johnson & Johnsonwe believe health is everything.Our strength in healthcare innovation empowers us to build aworld where complex diseases are prevented treated and curedwhere treatments are ...Show more
    Last updated: 11 days ago • Promoted
    Inpatient UM - Medical Director - Remote

    Inpatient UM - Medical Director - Remote

    UnitedHealth Group • San Diego, CA, United States
    Full-time
    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 connect...Show more
    Last updated: 2 days ago • Promoted
    Director, Clinical Laboratories

    Director, Clinical Laboratories

    San Diego Blood Bank • San Diego, CA, United States
    Full-time
    Are you passionate about making a real difference in your community? Are you looking for a job where you can contribute to a meaningful cause and grow professionally? If so, San Diego Blood Bank in...Show more
    Last updated: 5 days ago • Promoted
    Interim Director, Oncology

    Interim Director, Oncology

    HCT Healthcare Transformation • San Diego, CA, US
    Temporary
    HCT seeks an experienced professional to serve as the Interim Director, Oncology at outpatient facility in California.Education : BSN degree required, MSN preferred. Experience : 12 years of recent an...Show more
    Last updated: 5 days ago • Promoted
    Clinical Review Medical Director - Vascular Surgery - Remote

    Clinical Review Medical Director - Vascular Surgery - Remote

    UnitedHealth Group • San Diego, CA, United States
    Remote
    Full-time
    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 connect...Show more
    Last updated: 9 days ago • Promoted
    Physician / Cardiology / California / Permanent / Associate Medical Director - Cardiology - 100% Rem

    Physician / Cardiology / California / Permanent / Associate Medical Director - Cardiology - 100% Rem

    eviCore healthcare • San Diego, CA, US
    Part-time
    Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United Sta...Show more
    Last updated: 30+ days ago • Promoted
    SD / ED, Medical Director MD, Endocrinology

    SD / ED, Medical Director MD, Endocrinology

    Neurocrine Biosciences • San Diego, CA, United States
    Full-time
    SD / ED, Medical Director MD, Endo.Be among the first 25 applicants.At Neurocrine Biosciences, we pride ourselves on having a strong, inclusive, and positive culture based on our shared purpose and v...Show more
    Last updated: 18 days ago • Promoted