Medical Director – Prior Authorization – Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start

Caring. Connecting. Growing together.

Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 4 industry leader.

This position will support the growing Prior Auth program which covers the New Mexico, Utah, Nevada, and Arizona Markets. The scope of this role will include Prior Authorization for Medicare Advantage members focusing on high value procedures such as Myocardial SPECT, PET scans, DME / Home Ventilator, Genetic Testing, and many more. Additionally, the team handles UM functions for the Arizona and New Mexico markets.

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

Primary Responsibilities

Work to improve quality and promote evidence-based medicine

Prior authorization, utilization management and claims review cases for patients

Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement

Support initiatives that enhance quality throughout our national network

Ensure the right service is provided at the right time for each member

Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review

Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting

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.

Required Qualifications

MD or DO degree

Active, unrestricted physician state license

Current board certification in ABMS or AOA specialty

5+ years of clinical practice experience post residency

Proven solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles

Preferred Qualifications

Hands-on utilization and / or quality management experience

Prior Authorization experience

Project management or active project participation experience

Substantial experience in using electronic clinical systems

Licensure in New Mexico, Utah, Nevada, or Arizona (or willing and able to obtain)

All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Compensation for this specialty generally ranges from $269,500 – $425,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.

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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone—of every race, gender, sexuality, age, location and income—deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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