[Hiring] Medical Director @UnitedHealth Group

Role Description

Optum is currently seeking a Short Stay Billing Validation (SSBV) Medical Director to join our Clinical and Coding Audit (CCAT) team with Optum Insights. This team is responsible for conducting facility inpatient payment integrity audits addressing ambulatory or outpatient hospital encounters that are incorrectly billed as inpatient. The SSBV Medical Directors work with cross-functional clinical reviews of nurses and do not question the severity of a patient’s condition, nor the necessity of the care provided. Instead, Short-Stay Billing Validation determines whether the care provided was billed correctly. Optum’s SSBV Medical Directors are part of a national organization and team, and collaborate with peers, nurse managers, and non-clinical employees from across the country.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Provide physician-level review and determination of short-stay inpatient claims to ensure accurate billing status and alignment with evidence-based guidelines.
• Support audit integrity by delivering clear, defensible clinical rationale and partnering with clinical and operational teams to drive consistent review outcomes.
• Grounded in the use and application of evidence-based medicine (EBM) such as InterQual®.
• Responsible for collaborating with operational and business partners.
• Maintain proficiency in all required software and platforms.

Qualifications

• MD or DO with an active, unrestricted medical license in the U.S.
• Board certification up-to-date and in good standing.
• Current Board Certification in an ABMS or AOBMS specialty.
• 3+ years of clinical practice experience.
• Technical proficiency in computer software and systems.
• Proven ability to work collaboratively with nurses, coders, and operational partners in a matrixed environment.
• Demonstrated excellence with both written and oral communication skills across clinical and non-clinical audiences.

Requirements

• 2+ years of managed care, Quality Management experience and/or administrative leadership experience.
• Experience applying evidence-based level-of-care criteria (e.g., InterQual® or MCG) in utilization review or payment integrity settings.
• Experience with short-stay billing validation, inpatient status review, or physician advisory services in the acute care setting.
• Experience developing clear, well-supported clinical rationale for billing status determinations and audit findings.
• Knowledge of CMS guidelines, medical necessity review principles, and payer audit processes.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

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.