The Optum Specialty Pharmacy Programs Medical Director will provide utilization management services for our clients and clinical guidance for our next-generation comprehensive specialty pharmacy solution. This solution will help ensure providers deliver high-quality, evidence-based and cost-efficient specialty pharmacy care for our clients.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Serve as a subject matter expert in specialty pharmacy drugs covered under the medical benefit to include for example sodium hyaluronate, inflammatory, intravenous immunoglobulin and multiple sclerosis drugs
Perform utilization review determinations and support case and disease management teams to achieve optimal clinical outcomes
Engage & collaborate with treating providers telephonically. This will include discussion of evidence-based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expense
Enhance clinical expertise of the specialty pharmacy team through education sessions with nursing teams
Evaluate clinical and other data (e.g., quality metrics, claims & health record data, utilization data) to identify opportunities for improvement of clinical care and processes
At Optum, you will perform within an innovative culture that's focused on transformational change in the health care system. 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.
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.
MD or DO with an active, unrestricted medical license
Board Certified in a Medical Specialty
5+ years of clinical practice experience
Demonstrated accomplishments in any of the following areas: Utilization management, Case management, Disease management, Quality management
Experience working with clinical policy
Strong presentation skills and interpersonal skills
Strong computer skills to include MS Office and the ability to learn new technologies
Utilization management experience working in collaboration with a utilization management company, payor or hospital
Internal Medicine, Family Medicine
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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, Specialty Pharmacy, Healthcare, Health Care, Telecommute, Remote, Work from Home, WFH, Internal Medicine, Family Medicine, Internist
Unitedhealth Group Inc.