Community & State Medical Director - Colorado | Junction, |

Medical Director

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

The Medical Director provides leadership to the Health Plan's enterprise healthcare value effort and bed-day management processes, ensuring appropriate decisions are made that are in alignment with insurance product benefits and the level of care for members. Accountability includes oversight of medical & clinical processes with a focus on implementing plans of care that meet accepted guidelines and protocols and ensure that optimal and appropriate medical & clinical services are provided. The Medical Director educates and interacts with network and group providers as well as clinical and case management staff regarding utilization practices and effective resource management. The Medical Director is accountable to manage resource allocation as is applicable to medical management practices under his or her scope of responsibility.

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 review based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed in peer-to-peer telephone calls
• Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants; educates providers on benefit plans and UHC medical policy and utilization review guidelines
• Is available and accessible to the UM & Care Management staff throughout the day to respond to inquiries while serving as a clinical resource, coach, and leader
• Document clinical review findings, actions, and outcomes in accordance with Health Plan policies, and regulatory and accreditation requirements
• Actively participate in identifying and resolving problems and collaborates in process improvements that may include other Health Plan departments as well as key community stake holders and leaders
• Participate in senior medical management strategy development and implementation to ensure that appropriate care and services provided to members meet best practice standards as well as regulatory compliance requirements
• Support overall market, regional, and corporate goals to ensure continued growth and affordability of the Health Plan
• Review inpatient cases and is accountable for successful bed-day management that meets established company goals
• Analyze utilization data to identify trends and opportunities for process improvement related to medical treatment (inpatient and outpatient)
• Participate in HPRs for employer groups
• Participate in Appeals & PA
• Participate and support population health strategies where applicable
• Ability to contribute to the organization's efforts to eliminate racial and ethnic disparities in organizational performance and support cultural awareness

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:

• 10+ years of medical experience
• Active/unrestricted Medical License
• Active Board Certified in an ABMS/AOBMS specialty
• Broad and comprehensive knowledge of medical management principles and insurance products for multiple and varied lines of business in a managed care environment
• Solid knowledge of community health care environment, the provider network and managed care contracting processes
• Solid understanding of managed care systems, quality improvement and risk management

Preferred Qualifications:

• 8+ years of progressively responsible management experience preferably in a managed care setting
• Demonstrated excellent medical management and leadership skills
• Demonstrated excellent communication skills
• Proven team player and strong teambuilding skills
• Proven creative problem-solving skills
• Proven good skills in making presentations and teaching
• Proven solid organizational and prioritization skills

Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. 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.

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.