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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities.
Come make an impact on the communities we serve as you help us advance health equity on a global scale.
Join us to start Caring.
Connecting.
Growing together.
This Medical Director role in the Clinical & Coding Advisory Team (CCAT) is a rare opportunity to work directly within Optum Payer Operations.
As a member of CCAT, you will play a vital role in helping stop fraud, waste, abuse, and error and help healthcare work better every day.
The purpose of this job is to help people live their lives to the fullest by providing clinical leadership and expertise for the clinical investigation teams, including involvement in clinical reviews, provider education, high level appeals, development of clinical resources, and operations improvements.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities Provide expert clinical and strategic leadership for operational teamsCollaborate with clinical operations teams on complex or difficult casesApply clinical knowledge in the interpretation of medical policy, clinical resources, and benefit document language in the review of professional and facility pre-pay and post-pay clinical reviewsCollaborate with and educate network and non-network providers on cases and clinical coding situations in pursuit of accurate billing practicesActively participate in regular meetings and projects focused on clinical decision-making, clinical resources, analytics, savings, and staff trainingParticipate in development of medical policy, clinical resources, and guidelines utilized in the review of professional and facility pre-pay and post-pay clinical reviewsOther duties and goals assigned by the Sr. Medical DirectorCritical Success Factors Ability to effectively lead, manage and deliver in a fast pace, ever changing environmentSolid understanding of Fraud, Waste, Abuse, and Error methodologyAbility to foster communications, robust collaboration, and solid partnerships among providers, clients, leaders, and clinical teamsSolid problem-solving, negotiation and persuasion skillsYou'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
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