As a part of the OptumCare, the largest network of medical groups in the nation, ProHealth Physicians is seeking a full time Assistant Medical Director for Prior Authorization review. At Optum, we are transforming healthcare nationally while providing Physician-led care locally.
Work with the Optum Prior Authorization team to provide timely and appropriate medical necessity determinations
Assist in improving the prior authorization process
Provide assistance in appeals reviews where appropriate
Work with Chief Medical Officer and assigned staff on quality projects
Other duties as assigned by Chief Medical Officer
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.
Medical Doctor or Doctor of Osteopathy degree
Valid Medical License, any state
Working knowledge of managed care and Medicare Advantage
Experience with and demonstrated proficient use of Microsoft Office Suite, web based programs, EMRs and clinical documentation systems
Board Certification in Internal Medicine
Minimum of 5 years of Clinical experience. Experience in patient management in SNFs is preferred
Experience in Milliman Care guidelines, Medicare National and Local Coverage Determination Guidelines, and other utilization criteria
Knowledge of NCQA, URAC standards
Knowledge of inpatient services, palliative care, skilled nursing services, hospice care and outpatient care
Experience in working with senior populations
Ability to telecommute, after initial training period. All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Medical Director, Prior Authorizations, CT, Connecticut
Unitedhealth Group Inc.