OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you want more meaning in your career - as a clinician or a business professional - think of OptumHealth as your calling.
By providing 60 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals.
- The Medical Director models and promotes the core values of the Collaborative and OptumHealth.
- He/she is responsible for oversight and management of all utilization review and management activities.
- The Medical Director will provide clinical supervision to all Utilization Managers, oversee inpatient hospitalizations; and keep current regarding prevalent treatment protocols and philosophies including those that address consumer cultural preferences.
- The Medical Director will serve as liaison with the Appeals Department regarding appeals and grievances and supervises the medical necessity appeals process, supervises and maintains the logs and records, and serves as a direct participant as the respondent to appeals.
- Ensures the efficient operation of the utilization management staff members who provide triage, pre-assessment, pre-certification and continued stay reviews for consumers and providers, as well as utilization management and care coordination
- Ensures that all UM activities are performed in accordance with OptumHealth and Collaborative UM standards.
- Monitors team productivity, as well as the quality and consistency of UM determinations, utilization data, diversion rates, and referral and triage services
- Provides clinical supervision to the Utilization Managers
- Performs peer clinical review or appeals review per American Accreditation Health Care Commission/URAC Health Utilization Management guidelines
- Participates in the credentialing of psychiatric clinicians and in various QI/QM activities, committees, and audits
At OptumHealth, you will perform within an innovative culture that's focused on . You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
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