UM Medical Director - DME - Remote in US | Houston, Texas | Remote

Medical DirectorOptum 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization 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 for all lines of business. 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. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Working in PST is preferred.Primary Responsibilities:Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinationsDocument clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirementsEngage with requesting providers as needed in peer-to-peer discussionsBe knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviewsParticipate in daily clinical rounds as requestedCommunicate 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 policyCommunicate and collaborate with other internal partnersCall coverage rotationYou'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.OActive unrestricted license to practice medicineBoard certification in Physical Medicine & Rehabilitation, Internal Medicine, Family Medicine, general surgery, ortho surgery under American board or AOA board certifications5+ years of clinical practice experience after completing residency trainingSound understanding of Evidence Based Medicine (EBM)Proven solid PC skills, specifically using MS Word, Outlook, and ExcelPreferred Qualifications:Multiple State LicensesExperience in utilization and clinical coverage reviewData analysis and interpretation aptitudeInnovative problem-solving skillsExcellent oral, written, and interpersonal communication skills, facilitation skillsExcellent presentation skills for both clinical and non-clinical audiencesReside in Pacific Time ZonePay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $248,500 to $373,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.