Medical Director - Prior Authorization

Join Optum, a global leader in delivering healthcare powered by technology, and play a pivotal role in improving health outcomes for millions. You will be part of a culture that promotes inclusion, and offers talented peers, comprehensive benefits, and career development opportunities. Make a significant impact on the communities we serve and help us advance health optimization on a global scale. Together, we can start

Caring. Connecting. Growing together.

Are you looking to drive meaningful improvement in evidence-based medicine, patient safety, practice variation, and affordability? This is your chance to make a difference at UnitedHealth Group, a Fortune 4 industry leader, serving Medicare, Medicaid, and commercial members.

This position supports our expanding Prior Authorization program, focusing on Medicare Advantage members and high-value procedures including Myocardial SPECT, PET scans, DME / Home Ventilators, Genetic Testing, and more. You'll also engage in Utilization Management functions across various markets.

Enjoy the flexibility to work remotely from anywhere in the U.S. as you tackle important challenges.

Key Responsibilities :

Enhance quality and promote the use of evidence-based medicine.

Conduct prior authorizations, utilization management, and claims reviews for patients.

Provide essential information on quality and efficiency to healthcare providers, patients, and clients to inform their care decisions.

Support initiatives designed to elevate the quality of care throughout our national network.

Ensure timely delivery of the right services to each member.

Collaborate with medical director teams on inpatient care management, clinical coverage reviews, member appeals, medical claim reviews, and provider appeals.

Thrive in a technology-focused role requiring strong leadership skills and confidence to make independent decisions in a fast-paced environment.

Be recognized for your performance in a challenging environment that will guide you on what it takes to succeed in your role and support your career growth.

Required Qualifications :

MD or DO degree.

Active and unrestricted physician state license.

Current board certification in an ABMS or AOA specialty.

5+ years of clinical practice experience post-residency.

Strong understanding of and adherence to evidence-based medicine (EBM) and managed care principles.

Preferred Qualifications :

Experience in utilization and / or quality management.

Experience in prior authorization.

Project management experience or active participation in projects.

Proficient use of electronic clinical systems.

Licensure in New Mexico, Utah, Nevada, or Arizona (or the willingness to obtain one of these licenses).

Please note that all remote employees must comply with UnitedHealth Group's Telecommuter Policy.

The compensation range for this specialty is generally between $269,500 and $425,500, including base pay and bonuses. Compensation depends on various factors such as local labor markets, education, work experience, and may increase based on productivity and performance. We abide by all applicable minimum wage laws. Alongside your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase options, and 401k contributions (subject to eligibility requirements). No matter your starting point, you'll find extensive choices of benefits and incentives at UnitedHealth Group.

Application Deadline :

This position will be posted for a minimum of 2 business days or until a sufficient candidate pool has been established. Jobs may be removed early due to high volumes of applicants.

At UnitedHealth Group, we are dedicated to helping people live healthier lives and improving the health system for everyone. We believe that everyone, regardless of race, gender, sexuality, age, location, and income, deserves an opportunity for good health. We are committed to mitigating barriers to good health, especially for marginalized groups and low-income individuals. We aim to deliver equitable care that addresses health disparities and improves health outcomes, which is a priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer in compliance with applicable laws, ensuring qualified candidates receive consideration for employment without discrimination based on race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other characteristic protected by laws and regulations.

UnitedHealth Group maintains a drug-free workplace, and candidates are required to pass a drug test prior to starting employment.