[Hiring] Orthopedic or Spine Medical Director @UnitedHealth Group

Role Description

As part of the Focus Claims Review team at Optum, the Medical Director provides leadership, organization, and direction for the claims review program. The Medical Director will participate in all aspects of claim review services including provider telephonic discussions and provider appeals. In addition, the Medical Director may also be asked to assist in the direction and oversight in the development and implementation of coding and procedures.

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

• Remote Schedule: Monday through Friday, flexible 8 hr. shifts; no weekends
• Reviews surgical & spinal claims for correct coding using clinical record
• Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
• Discuss cases and clinical coding situations with treating providers telephonically during scheduled hours
• Participates in periodic coding conferences / calls and in ongoing internal performance consistency reviews
• Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers)
• Provide Clinical support for staff that conduct initial reviews

Qualifications

• Current, active, and fully unrestricted medical license
• Current board certification in Orthopedic Surgery
• 5+ years of clinical experience in Orthopedic surgery; specialized in spinal surgery post residency
• Proficient in MS Office (MS Word, Excel, and Power Point)

Requirements

• Experience in managed care
• Experience with professional claim coding / claim coding reviews
• Knowledge of claim coding resources and techniques
• Proficient computer skills and ability to learn to use clinical and claims software
• Proven excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)
• Salary range: $248,500.00 to $373,000.00 annually based on full-time employment

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.