Optum

Medical Director - Post-Acute Care Management - Care Transitions - Remote

Boston, MA

full-time
Inpatient and outpatient

Primary Responsibilities:

  • Provide daily utilization oversight and external communication with network physicians and hospitals
  • Daily UM reviews - authorizations and denial reviews
  • Conduct peer to peer conversations for the clinical case reviews, as needed
  • Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
  • Communicate effectively with network and non-network providers to ensure the successful administering of Care Transitions’ services
  • Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
  • Represent Care Transitions on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders
  • Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers
  • Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
  • Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees
  • Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting
  • Regularly meet with Care Transitions’ leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues
  • Provide input on local needs for Analytics Team and Client Services Team to better enhance Care Transitions’ products and services
  • Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME
  • Participate on the Medical Advisory Board
  • Providing intermittent, scheduled weekend and evening coverage
  • Perform other duties and responsibilities as required, assigned, or requested

Required Qualifications:

  • Board certification as an MD, DO, MBBS with a current unrestricted license to practice and maintain necessary credentials to retain the position
  • Current, unrestricted medical license and the ability to obtain licensure in multiple states
  • 3+ years of post-residency patient care, preferably in inpatient or post-acute setting

Preferred Qualifications:

  • Licensure in multiple states
  • Willing to obtain additional state licenses, with Optum’s support
  • Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care
  • Demonstrated ability to work within a team environment while completing multiple tasks simultaneously
  • Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision
  • Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non-medical professionals
  • Demonstrated competence in use of electronic health records as well as associated technology and applications
  • Proven excellent organizational, analytical, verbal and written communication skills
  • Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues
  • Proven highest level of ethics and integrity
  • Proven highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment

Posted October 31, 2024

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